Basic Information
Provider Information
NPI: 1104846526
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SPRESNEY
FirstName: DEBORAH
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: M.A., CCC-SLP
OtherOrganizationName:  
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OtherLastName:  
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Mailing Information
Address1: 4646 JOHN R ST
Address2: AUDIOLOGY AND SPEECH PATHOLOGY
City: DETROIT
State: MI
PostalCode: 482011916
CountryCode: US
TelephoneNumber: 3135761000
FaxNumber: 3135761092
Practice Location
Address1: 4646 JOHN R ST
Address2: AUDIOLOGY AND SPEECH PATHOLOGY
City: DETROIT
State: MI
PostalCode: 482011916
CountryCode: US
TelephoneNumber: 3135761000
FaxNumber: 3135761092
Other Information
ProviderEnumerationDate: 07/20/2006
LastUpdateDate: 11/24/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X7101004116MIY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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