Provider Demographics
NPI:1801297304
Name:NEIL, DEBRA (SLP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:NEIL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 DAVIDSON SIDING RD
Mailing Address - Street 2:
Mailing Address - City:GRINDSTONE
Mailing Address - State:PA
Mailing Address - Zip Code:15442-1143
Mailing Address - Country:US
Mailing Address - Phone:724-785-6960
Mailing Address - Fax:479-709-7747
Practice Address - Street 1:405 DAVIDSON SIDING RD
Practice Address - Street 2:
Practice Address - City:GRINDSTONE
Practice Address - State:PA
Practice Address - Zip Code:15442-1143
Practice Address - Country:US
Practice Address - Phone:724-785-6960
Practice Address - Fax:479-709-7747
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL002678L235Z00000X
WVSLP-0779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist