Provider Demographics
NPI:1811328859
Name:SALTZMAN, DEBRA LYNNE
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LYNNE
Last Name:SALTZMAN
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 1:1325 N THEIS LN
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-1245
Mailing Address - Country:US
Mailing Address - Phone:262-268-5893
Mailing Address - Fax:
Practice Address - Street 1:1325 N THEIS LN
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074-1245
Practice Address - Country:US
Practice Address - Phone:262-268-5893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIS432000045299235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI01092506OtherASHA NUMBER