Provider Demographics
NPI:1760157663
Name:DEBALKO, DANA
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:DEBALKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2467
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29465-2467
Mailing Address - Country:US
Mailing Address - Phone:850-341-0418
Mailing Address - Fax:
Practice Address - Street 1:300 SEAPORT LN UNIT 1224
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3099
Practice Address - Country:US
Practice Address - Phone:850-341-0418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist