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General NPI Number Information
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NPI Number | 1447621206
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Entity Type | Organization
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Legal Business Name | MOBILE DYSPHAGIA SPECIALISTS
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Dates
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Enumeration Date | 10/19/2015
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 2209A E SLADE LN
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City | MAHOMET
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State | IL
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Zip | 61853-2816
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Country | US
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Telephone | 217-377-3568
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Fax |
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Provider Business Mailing Address
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Address Line | 2209A E SLADE LN
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City | MAHOMET
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State | IL
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Zip | 61853-2816
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Country | US
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Telephone | 217-377-3568
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DEBBIE D HARPER
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Credential |
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Telephone | 217-377-3568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146.003458
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License Number State | IL
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