=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982567699
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH LYLES CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2025
-----------------------------------------------------
Last Update Date | 12/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 W HENDRICKSON RD
-----------------------------------------------------
City | SEQUIM
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98382-3367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-582-3563
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 W HENDRICKSON RD
-----------------------------------------------------
City | SEQUIM
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98382-3367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-582-3563
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | LL70045152
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------