Provider Demographics
NPI:1689726887
Name:SMITH, DEBRA L (MA)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2136
Mailing Address - Country:US
Mailing Address - Phone:402-280-8100
Mailing Address - Fax:402-280-8103
Practice Address - Street 1:425 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2100
Practice Address - Country:US
Practice Address - Phone:402-452-5000
Practice Address - Fax:402-452-5028
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101231H00000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE36837OtherBCBS ENT
NE36829OtherBCBS BT
IA0587618Medicaid
NE100251704-00Medicaid
IA1587618Medicaid
IA2587618Medicaid
NE100251703-00Medicaid
IA3587618Medicaid
IA3587618Medicaid