Provider Demographics
NPI:1780746297
Name:POWELL, DEBORAH RENEE (MS)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:RENEE
Last Name:POWELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 HOWE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3364
Mailing Address - Country:US
Mailing Address - Phone:916-927-3137
Mailing Address - Fax:916-927-3138
Practice Address - Street 1:1325 HOWE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3364
Practice Address - Country:US
Practice Address - Phone:916-927-3137
Practice Address - Fax:916-927-3138
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1088231H00000X
CAHA2328237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0010880Medicaid
171790600OtherOWCP
CA680434558OtherTAX ID
CA680434558OtherTAX ID