Healthcare Provider Details

I. General information

NPI: 1982567699
Provider Name (Legal Business Name): DEBORAH LYLES CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W HENDRICKSON RD
SEQUIM WA
98382-3367
US

IV. Provider business mailing address

301 W HENDRICKSON RD
SEQUIM WA
98382-3367
US

V. Phone/Fax

Practice location:
  • Phone: 360-582-3563
  • Fax:
Mailing address:
  • Phone: 360-582-3563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL70045152
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: