Provider Demographics
NPI:1760716435
Name:KRUCHOWY, DEBORAH (MACCC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:KRUCHOWY
Suffix:
Gender:F
Credentials:MACCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6486 PALOMINO CIR
Mailing Address - Street 2:
Mailing Address - City:SOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:93066-9740
Mailing Address - Country:US
Mailing Address - Phone:805-386-7939
Mailing Address - Fax:
Practice Address - Street 1:6486 PALOMINO CIR
Practice Address - Street 2:
Practice Address - City:SOMIS
Practice Address - State:CA
Practice Address - Zip Code:93066-9740
Practice Address - Country:US
Practice Address - Phone:805-386-7939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP8608235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist