Provider Demographics
NPI:1316350614
Name:JOVICIC, DEBRA
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:JOVICIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 W 47TH ST
Mailing Address - Street 2:
Mailing Address - City:SHADYSIDE
Mailing Address - State:OH
Mailing Address - Zip Code:43947-1046
Mailing Address - Country:US
Mailing Address - Phone:740-676-7445
Mailing Address - Fax:
Practice Address - Street 1:55707 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:OH
Practice Address - Zip Code:43912-1516
Practice Address - Country:US
Practice Address - Phone:740-635-0853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.7350235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist