Provider Demographics
NPI:1730700436
Name:WEST, DEBORAH (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12461 FAIRFAX RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-5475
Mailing Address - Country:US
Mailing Address - Phone:512-529-0750
Mailing Address - Fax:
Practice Address - Street 1:1701 LOHMANS CROSSING RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734-5157
Practice Address - Country:US
Practice Address - Phone:512-553-6350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18736235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist