Provider Demographics
NPI:1174918510
Name:MAYHEW, DEBRA LYNN (HAD)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LYNN
Last Name:MAYHEW
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W ROUTE 66
Mailing Address - Street 2:SUITE A
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6202
Mailing Address - Country:US
Mailing Address - Phone:626-963-1234
Mailing Address - Fax:909-625-7134
Practice Address - Street 1:102 W ROUTE 66
Practice Address - Street 2:SUITE A
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6202
Practice Address - Country:US
Practice Address - Phone:626-963-1234
Practice Address - Fax:909-625-7134
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA3178237600000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist