Provider Demographics
NPI:1740458496
Name:HAWN, DEBRA GREENE (MA/CCC-SLP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:GREENE
Last Name:HAWN
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 1:415 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5909
Mailing Address - Country:US
Mailing Address - Phone:828-234-5445
Mailing Address - Fax:828-754-9663
Practice Address - Street 1:6 PARK SQ
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28630-1528
Practice Address - Country:US
Practice Address - Phone:828-234-5445
Practice Address - Fax:828-754-9663
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1690235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1740458496Medicaid