Provider Demographics
NPI:1962627018
Name:MCPHERSON, DEBRA LEE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LEE
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3048
Mailing Address - Country:US
Mailing Address - Phone:321-773-4471
Mailing Address - Fax:
Practice Address - Street 1:2040 HIGHWAY A1A STE 203
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3566
Practice Address - Country:US
Practice Address - Phone:321-773-8989
Practice Address - Fax:321-773-8990
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA3900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL883361300Medicaid