Provider Demographics
NPI:1740303361
Name:CONTOVEROS, DEBBIE (ST)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:CONTOVEROS
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6558 SAINT MORITZ AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2428
Mailing Address - Country:US
Mailing Address - Phone:214-826-8984
Mailing Address - Fax:
Practice Address - Street 1:6558 SAINT MORITZ AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2428
Practice Address - Country:US
Practice Address - Phone:214-826-8984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14909235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14909OtherLICENSE NUMBER