Provider Demographics
NPI:1144364407
Name:DAVISON, DEBORAH LYNNE (SLP)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LYNNE
Last Name:DAVISON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 WYNOOCHEE WAY
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-2332
Mailing Address - Country:US
Mailing Address - Phone:707-763-6419
Mailing Address - Fax:707-763-2537
Practice Address - Street 1:1301 REDWOOD WAY STE 165
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-1136
Practice Address - Country:US
Practice Address - Phone:707-763-6419
Practice Address - Fax:707-763-2537
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP13919235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist