Provider Demographics
NPI:1124486501
Name:ADDY, DEBRA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:ADDY
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 1:215 E 51ST ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-2239
Mailing Address - Country:US
Mailing Address - Phone:912-232-2213
Mailing Address - Fax:
Practice Address - Street 1:6711 LAROCHE AVE
Practice Address - Street 2:RIVERVIEW HEALTH AND REHABILITATION
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406
Practice Address - Country:US
Practice Address - Phone:912-354-8225
Practice Address - Fax:912-790-3238
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005223235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist