MEDICARE: DEBORAH TAYLOR DELONG 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	10271	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10271	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1487858619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH TAYLOR DELONG SLP

Provider Business Mailing Address
First Line	:	2588 15TH AVE
Second Line	:
City	:	KINGSBURG
State	:	CA
Zip	:	93631-1109
Country	:	US
Telephone Number	:	559-897-2276
Fax Number	:	559-869-6075

Provider Business Practice Location Address
First Line	:	1118 N CHINOWTH ST
Second Line	:
City	:	VISALIA
State	:	CA
Zip	:	93291-7896
Country	:	US
Telephone Number	:	559-741-9687
Fax Number	:	559-741-9694

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

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	07/21/2022

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