Provider Demographics
NPI:1669849006
Name:SMITH, DEBRA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:SMITH
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 1:1080 S LA CIENEGA BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2680
Mailing Address - Country:US
Mailing Address - Phone:323-426-6402
Mailing Address - Fax:
Practice Address - Street 1:1080 S LA CIENEGA BLVD STE 208
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2680
Practice Address - Country:US
Practice Address - Phone:323-426-6402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist