Healthcare Provider Details

I. General information

NPI: 1750360533
Provider Name (Legal Business Name): DEIRDRE ANNE POWERS M.ED.,CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 BUTLER AVE DEPTARTMENT OF VETERAN'S AFFAIRS
MARTINSBURG WV
25401-9990
US

IV. Provider business mailing address

2606 OPEQUON LN
KEARNEYSVILLE WV
25430-2609
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-0811
  • Fax:
Mailing address:
  • Phone: 304-267-7842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-0185
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: