Provider Demographics
NPI:1295955235
Name:SUFFOLK, DEBRA RAE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:RAE
Last Name:SUFFOLK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 N BRIARCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1010
Mailing Address - Country:US
Mailing Address - Phone:330-533-9014
Mailing Address - Fax:
Practice Address - Street 1:518 N BRIARCLIFF DR
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-1010
Practice Address - Country:US
Practice Address - Phone:330-533-9014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-2087235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist