Provider Demographics
NPI:1760594550
Name:KING, DEBORAH E (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:E
Last Name:KING
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:E
Other - Last Name:FALSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:9604 COLDWATER RD STE 107
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2096
Mailing Address - Country:US
Mailing Address - Phone:260-387-5820
Mailing Address - Fax:855-828-7823
Practice Address - Street 1:9604 COLDWATER RD STE 101
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2096
Practice Address - Country:US
Practice Address - Phone:260-387-5820
Practice Address - Fax:855-828-7823
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23001870A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200280930Medicaid