Healthcare Provider Details

I. General information

NPI: 1447308788
Provider Name (Legal Business Name): DEBORAH ANN WALTERS-SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 9TH ST SE
ROCHESTER MN
55904-6425
US

IV. Provider business mailing address

1650 4TH ST SE
ROCHESTER MN
55904-4717
US

V. Phone/Fax

Practice location:
  • Phone: 507-529-6610
  • Fax:
Mailing address:
  • Phone: 507-529-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number6280
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number6280
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number6280
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number6280
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: