Provider Demographics
NPI:1255063095
Name:DEBRA G HAWN
Entity type:Organization
Organization Name:DEBRA G HAWN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:HAWN
Authorized Official - Suffix:
Authorized Official - Credentials:MA/CCC-SLP
Authorized Official - Phone:828-234-5445
Mailing Address - Street 1:415 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5909
Mailing Address - Country:US
Mailing Address - Phone:828-234-5445
Mailing Address - Fax:828-754-9663
Practice Address - Street 1:6 PARK SQ
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28630-1528
Practice Address - Country:US
Practice Address - Phone:828-234-5445
Practice Address - Fax:828-754-9663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC863187OtherOPTUM HEALTH
NC2034237OtherWELLCARE
NC64240866OtherAMERIHEALTH CARITAS
NC07037338OtherHBNC AVAILITY
NC1740458496Medicaid