Provider Demographics
NPI:1720650716
Name:BASSETT, DEANNA LYNN (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:LYNN
Last Name:BASSETT
Suffix:
Gender:F
Credentials:MS 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:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:ELMORA
Mailing Address - State:PA
Mailing Address - Zip Code:15737-0133
Mailing Address - Country:US
Mailing Address - Phone:814-381-9911
Mailing Address - Fax:
Practice Address - Street 1:277 HOFFMAN AVE
Practice Address - Street 2:
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963-2369
Practice Address - Country:US
Practice Address - Phone:814-467-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-11
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASLP12269235Z00000X
PASLO12269235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist