Provider Demographics
NPI:1952735490
Name:JABLONSKI, DEBRA BETH (SLP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:BETH
Last Name:JABLONSKI
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 1:2132 NE LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-5341
Mailing Address - Country:US
Mailing Address - Phone:971-255-9761
Mailing Address - Fax:
Practice Address - Street 1:9414 NE FOURTH PLN RD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662
Practice Address - Country:US
Practice Address - Phone:360-892-5142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-01
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60500815235Z00000X
OR16019235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist