MEDICARE: DEBORAH REYNOLDS M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	017884	NY
2	235Z00000X	Speech-Language Pathologist	SL009106	PA

General Provider Information

NPI Number	:	1366646721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH REYNOLDS M.A.

Provider Business Mailing Address
First Line	:	12717 DEER PATH DR
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18302-8643
Country	:	US
Telephone Number	:	917-604-8319
Fax Number	:

Provider Business Practice Location Address
First Line	:	12717 DEER PATH DR
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18302-8643
Country	:	US
Telephone Number	:	917-604-8319
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	03/12/2012

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Directions to “ DEBORAH REYNOLDS M.A.” Practice Location

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