Provider Demographics
NPI:1598198681
Name:DEBLONDIN-CHASE, MARY (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DEBLONDIN-CHASE
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11506 NICHOLAS ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4407
Mailing Address - Country:US
Mailing Address - Phone:877-230-3885
Mailing Address - Fax:402-505-9753
Practice Address - Street 1:11506 NICHOLAS ST
Practice Address - Street 2:SUITE 110
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4407
Practice Address - Country:US
Practice Address - Phone:877-230-3885
Practice Address - Fax:402-505-9753
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1070235Z00000X
OR15064235Z00000X
PASL011501235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1070OtherKENTUCKY LICENSE NUMBER
PASL011501OtherPA LICENSE
OR15064OtherOREGON LICENSE