Provider Demographics
NPI:1033476346
Name:MAYES, REBECCA RUTH (MS, CFY-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:RUTH
Last Name:MAYES
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 LAGO CIR
Mailing Address - Street 2:APT #303
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-3200
Mailing Address - Country:US
Mailing Address - Phone:321-890-6863
Mailing Address - Fax:
Practice Address - Street 1:950 TUPELO RD SW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32908-7554
Practice Address - Country:US
Practice Address - Phone:321-952-5990
Practice Address - Fax:321-952-5992
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 5643235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist