Provider Demographics
NPI:1720539687
Name:ANDERSEN, DEBORAH E (SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:E
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:E
Other - Last Name:YOUNGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP-CCC
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-0009
Mailing Address - Country:US
Mailing Address - Phone:281-354-3383
Mailing Address - Fax:281-354-6750
Practice Address - Street 1:23750 FM 1314 RD
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-3713
Practice Address - Country:US
Practice Address - Phone:281-354-3383
Practice Address - Fax:281-354-6750
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109131235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist