Provider Demographics
NPI:1487968848
Name:AKINYELE, DEBORAH BOLANLE (CCC-SLP, CERTMRCSLT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:BOLANLE
Last Name:AKINYELE
Suffix:
Gender:F
Credentials:CCC-SLP, CERTMRCSLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 ARMY NAVY DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2905
Mailing Address - Country:US
Mailing Address - Phone:703-813-6330
Mailing Address - Fax:301-710-6379
Practice Address - Street 1:2445 ARMY NAVY DR
Practice Address - Street 2:SUITE 305
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-2905
Practice Address - Country:US
Practice Address - Phone:703-813-6330
Practice Address - Fax:301-710-6379
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005945235Z00000X
DCSLP000360235Z00000X
MD06467235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1487968848Medicaid
MD037761900Medicaid