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General NPI Number Information
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NPI Number | 1952706160
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Entity Type | Individual
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Provider Name | DEBORAH LEAH SELF M.S.,C.C.C.
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Gender | Female
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 10/30/2014
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Provider Practice Location Address
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Address Line | 601 W MCARTHUR ST
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City | MADILL
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State | OK
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Zip | 73446-2846
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Country | US
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Telephone | 580-795-3680
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Fax |
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Provider Business Mailing Address
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Address Line | 1108 W LILLIE BLVD
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City | MADILL
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State | OK
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Zip | 73446-2046
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Country | US
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Telephone | 580-263-0154
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 264
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License Number State | OK
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