Provider Demographics
NPI:1265710891
Name:KURTZ, DEBRA J (SLP/L)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:KURTZ
Suffix:
Gender:F
Credentials:SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 COUNTY ROAD 24
Mailing Address - Street 2:
Mailing Address - City:SHERBURNE
Mailing Address - State:NY
Mailing Address - Zip Code:13460-5501
Mailing Address - Country:US
Mailing Address - Phone:607-335-1379
Mailing Address - Fax:607-335-1268
Practice Address - Street 1:151 COUNTY ROAD 24
Practice Address - Street 2:
Practice Address - City:SHERBURNE
Practice Address - State:NY
Practice Address - Zip Code:13460-5501
Practice Address - Country:US
Practice Address - Phone:607-335-1379
Practice Address - Fax:607-335-1268
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005020-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist