Provider Demographics
NPI:1386793560
Name:TOWSLEY, DEBRA (DEBRA TOWSLEY)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:TOWSLEY
Suffix:
Gender:F
Credentials:DEBRA TOWSLEY
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:L
Other - Last Name:TOWSLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDS, CCC-SLP
Mailing Address - Street 1:120 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-3451
Mailing Address - Country:US
Mailing Address - Phone:208-233-3857
Mailing Address - Fax:
Practice Address - Street 1:120 DUKE ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3451
Practice Address - Country:US
Practice Address - Phone:208-233-3857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1155235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01065384OtherASHA CERTIFICATION
ID000010156507OtherREGENCE BLUE SHIELD ID NU