Provider Demographics
NPI:1144310541
Name:VENKATESH, DEBRA K (AUD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:K
Last Name:VENKATESH
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 1:2501 E SOUTHERN AVE
Mailing Address - Street 2:SUITE 21
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7669
Mailing Address - Country:US
Mailing Address - Phone:480-833-4330
Mailing Address - Fax:480-833-1902
Practice Address - Street 1:2501 E SOUTHERN AVE
Practice Address - Street 2:SUITE 21
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7669
Practice Address - Country:US
Practice Address - Phone:480-833-4330
Practice Address - Fax:480-833-1902
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA1670231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0902100OtherBLUE CROSS BLUE SHIELD
AZ470659OtherAHCCCS PROVIDER NUMBER
AZ0902100OtherBLUE CROSS BLUE SHIELD
AZ69229Medicare ID - Type UnspecifiedPROVIDER NUMBER