Provider Demographics
NPI:1013161033
Name:SLOCUM, DEBORAH LEE (MAG, RD, LD/N, CDE)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LEE
Last Name:SLOCUM
Suffix:
Gender:F
Credentials:MAG, RD, LD/N, CDE
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:LEE
Other - Last Name:CROWSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:580 FOX RUN CIR
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-8607
Mailing Address - Country:US
Mailing Address - Phone:904-588-8656
Mailing Address - Fax:904-276-8506
Practice Address - Street 1:480 WEST LOWDER STREET
Practice Address - Street 2:BAKER COUNTY HEALTH DEPARTMENT
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063
Practice Address - Country:US
Practice Address - Phone:904-259-6291
Practice Address - Fax:904-259-1950
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3270133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered