Doctor Name: | MRS. JESSIE LYNN DERBY |
NPI Number: | 1770899106 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. SLP |
License Number: | 259 |
Business Practice Address: | 7 Elliott St Council Bluffs, IA - 515030239 |
Business Phone Number: | 7123289500 |
Business Fax Number: | |
Mailing Address: | Po Box 123, SOUTH BEND |
State: | NE |
Postal Code: | 680580123 |
Phone Number: | 4026792338 |
Fax Number: | |
NPI Enumeration Date: | 08/23/2010 |
NPI Last Update Date: | 05/06/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 259 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NE |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |