Provider Demographics
NPI:1750671731
Name:LAND DEANS, INGRAM CLAUDETTE (MA/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:INGRAM
Middle Name:CLAUDETTE
Last Name:LAND DEANS
Suffix:
Gender:F
Credentials:MA/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27856-1716
Mailing Address - Country:US
Mailing Address - Phone:252-451-2895
Mailing Address - Fax:
Practice Address - Street 1:930 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:NC
Practice Address - Zip Code:27856-1716
Practice Address - Country:US
Practice Address - Phone:252-451-2895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5228235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist