Provider Demographics
NPI:1780839688
Name:VITTITOW, DEBRA DESHA
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:DESHA
Last Name:VITTITOW
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 1:2400 WEST MARKHAM
Mailing Address - Street 2:P.O. BOX 3811
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72203-3811
Mailing Address - Country:US
Mailing Address - Phone:501-324-9510
Mailing Address - Fax:501-324-3513
Practice Address - Street 1:2400 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6129
Practice Address - Country:US
Practice Address - Phone:501-324-9510
Practice Address - Fax:501-324-3513
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP8152235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist