Healthcare Provider Details

I. General information

NPI: 1508340266
Provider Name (Legal Business Name): DEBOLINA GHOSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7108 NOLAND RD
SHAWNEE KS
66216-4124
US

IV. Provider business mailing address

7108 NOLAND RD
SHAWNEE KS
66216-4124
US

V. Phone/Fax

Practice location:
  • Phone: 248-921-2493
  • Fax:
Mailing address:
  • Phone: 248-921-2493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: