Provider Demographics
NPI:1639209299
Name:SHOOP, DEBORAH H
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:H
Last Name:SHOOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6142 W MICHELLE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1113
Mailing Address - Country:US
Mailing Address - Phone:602-843-0716
Mailing Address - Fax:
Practice Address - Street 1:1235 E HARMONT DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-3864
Practice Address - Country:US
Practice Address - Phone:602-331-1470
Practice Address - Fax:602-678-5803
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0374235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist