Provider Demographics
NPI:1790013456
Name:HARDY, DEBORAH REYNOLDS (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:REYNOLDS
Last Name:HARDY
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC/SLP
Mailing Address - Street 1:4556 SHARON VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5952
Mailing Address - Country:US
Mailing Address - Phone:404-788-5776
Mailing Address - Fax:770-918-3050
Practice Address - Street 1:4556 SHARON VALLEY CT
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-5952
Practice Address - Country:US
Practice Address - Phone:404-788-5776
Practice Address - Fax:770-918-3050
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP000455235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist