Provider Demographics
NPI:1770507964
Name:LOEST DEPPE, DEBORAH (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:LOEST DEPPE
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:LOEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:1212 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:WESTHAVEN
Mailing Address - State:CA
Mailing Address - Zip Code:95570-9502
Mailing Address - Country:US
Mailing Address - Phone:707-445-9545
Mailing Address - Fax:707-445-9545
Practice Address - Street 1:3009 HUBBARD LN
Practice Address - Street 2:SUITE A
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4800
Practice Address - Country:US
Practice Address - Phone:707-445-9545
Practice Address - Fax:707-445-9545
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP6870235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP6870OtherLICENSE NUMBER USED BY IN
CASP0068700Medicaid
CASP6870OtherLICENSE NUMBER USED BY IN