Individual
DEANNA PHELPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
401 TIMBER RIDGE DR, # 3, GRAFTON, IL 62037-1134
(618) 977-5286
Mailing address
401 TIMBER RIDGE DR, # 3, GRAFTON, IL 62037-1134
(618) 977-5286
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
01110
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01110
STATE OF MISSOURI, MISSOURI BOARD OF HEALING ARTS
MO
Enumeration date
02/08/2012
Last updated
02/08/2012
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