Provider Demographics
NPI:1588640809
Name:BRADY, DEBORAH LYNN (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LYNN
Last Name:BRADY
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:WHITEHURST
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA CCC SLP
Mailing Address - Street 1:289 WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NC
Mailing Address - Zip Code:28675-8211
Mailing Address - Country:US
Mailing Address - Phone:336-372-4402
Mailing Address - Fax:336-372-7420
Practice Address - Street 1:289 WESTVIEW DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NC
Practice Address - Zip Code:28675-8211
Practice Address - Country:US
Practice Address - Phone:336-372-4402
Practice Address - Fax:336-372-7420
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2474235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01089394OtherASHA
NC7412518Medicaid