MEDICARE: MRS. DEBORAH ANN ANTONE SLP

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	SP 3473	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SP 3473	OTHER	CA	SPEECH PATHOLOGY LICENSE

General Provider Information

NPI Number	:	1396942587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH ANN ANTONE SLP

Provider Business Mailing Address
First Line	:	1079 GLENHAVEN DR
Second Line	:
City	:	PACIFIC PALISADES
State	:	CA
Zip	:	90272-2204
Country	:	US
Telephone Number	:	310-454-7347
Fax Number	:

Provider Business Practice Location Address
First Line	:	3205 OCEAN PARK BLVD
Second Line	:	SUITE 120
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-3224
Country	:	US
Telephone Number	:	310-581-6430
Fax Number	:

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

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	07/08/2007

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