Provider Demographics
NPI:1851600274
Name:HORTON, DEBRA (MSE, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
Credentials:MSE, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:AR
Mailing Address - Zip Code:72042-2903
Mailing Address - Country:US
Mailing Address - Phone:870-674-1402
Mailing Address - Fax:
Practice Address - Street 1:905 W 10TH ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:AR
Practice Address - Zip Code:72042-2903
Practice Address - Country:US
Practice Address - Phone:870-674-1402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP638235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR120048721Medicaid