Provider Demographics
NPI:1851636948
Name:WIDICK, DEBORAH
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:WIDICK
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 1:4004 HILLSBORO RD
Mailing Address - Street 2:STE 140
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2791
Mailing Address - Country:US
Mailing Address - Phone:615-297-3939
Mailing Address - Fax:615-297-8737
Practice Address - Street 1:4004 HILLSBORO RD
Practice Address - Street 2:STE 140
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2791
Practice Address - Country:US
Practice Address - Phone:615-297-3939
Practice Address - Fax:615-297-8737
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN617237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist