Basic Information
| Provider Information | |||||||||
| NPI: | 1679665905 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHARZEWSKI | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 85 SCENIC DRIVE | ||||||||
| Address2: | |||||||||
| City: | WEST WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028935499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013331135 | ||||||||
| FaxNumber: | 4012773366 | ||||||||
| Practice Location | |||||||||
| Address1: | 134 THURBERS AVE. | ||||||||
| Address2: | C/O FAMILY SERVICE OF RHODE ISLAND | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013311350 | ||||||||
| FaxNumber: | 4012773366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP00722 | RI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 5883 | MA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 46-00025 | 01 | UNITED HEALTH | OTHER | 27260-1 | 01 | BLUE CROSS/BLUE SHIELD | OTHER | 411520 | 01 | BLUE CHIP | OTHER |