Healthcare Provider Details

I. General information

NPI: 1235435462
Provider Name (Legal Business Name): DEBORAH LYNN MAGUIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2011
Last Update Date: 02/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N JEFFERSON ST
ROANOKE VA
24016-1427
US

IV. Provider business mailing address

140 TALUS LN NW APT 102
CHRISTIANSBURG VA
24073-4085
US

V. Phone/Fax

Practice location:
  • Phone: 540-345-5111
  • Fax:
Mailing address:
  • Phone: 540-357-1563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202006213
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: