Provider Demographics
NPI:1306984166
Name:WALDMAN, DEBORAH SCANNELL (AUD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SCANNELL
Last Name:WALDMAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 E 1ST ST
Mailing Address - Street 2:UNIT 201
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-1733
Mailing Address - Country:US
Mailing Address - Phone:508-954-9488
Mailing Address - Fax:
Practice Address - Street 1:45 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6105
Practice Address - Country:US
Practice Address - Phone:617-525-6505
Practice Address - Fax:617-525-6511
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA395231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist