Provider Demographics
NPI:1336177559
Name:BROCKWAY, DEBRA ELIZABETH (MA, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ELIZABETH
Last Name:BROCKWAY
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FILE #55745
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-5745
Mailing Address - Country:US
Mailing Address - Phone:562-804-3119
Mailing Address - Fax:562-804-1882
Practice Address - Street 1:14359-61 CLARK AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-2901
Practice Address - Country:US
Practice Address - Phone:562-804-3119
Practice Address - Fax:562-804-1882
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU766231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWAU766BMedicare PIN