Provider Demographics
NPI:1194931147
Name:MCBRIDE, DEBRA L (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 1944
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80437-1944
Mailing Address - Country:US
Mailing Address - Phone:303-358-4849
Mailing Address - Fax:
Practice Address - Street 1:5351 THREE SISTERS CIR
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7501
Practice Address - Country:US
Practice Address - Phone:303-358-4849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0000821235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist