Provider Demographics
NPI:1689115677
Name:SPELLMAN, DEBORAH BETH (SLP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:BETH
Last Name:SPELLMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:BETH
Other - Last Name:YAKER-SPELLMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7031 ALDEA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE BALBOA
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3621
Mailing Address - Country:US
Mailing Address - Phone:818-599-5442
Mailing Address - Fax:
Practice Address - Street 1:7031 ALDEA AVE
Practice Address - Street 2:
Practice Address - City:LAKE BALBOA
Practice Address - State:CA
Practice Address - Zip Code:91406-3621
Practice Address - Country:US
Practice Address - Phone:818-599-5442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14303736235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist