Provider Demographics
NPI:1851497804
Name:LIGHTFOOT, DEBRA ANN (CCC-A)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:LIGHTFOOT
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:175 ELIZABETH BLACKWELL ST
Practice Address - Street 2:7TH FLOOR JACOBSEN HALL
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2326
Practice Address - Country:US
Practice Address - Phone:315-464-4806
Practice Address - Fax:315-464-5321
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001112-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist