Provider Demographics
NPI:1043401243
Name:DEQUESADA, REBECCA EILEEN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:EILEEN
Last Name:DEQUESADA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 SW 82ND CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5247
Mailing Address - Country:US
Mailing Address - Phone:305-263-9728
Mailing Address - Fax:305-262-9094
Practice Address - Street 1:1501 SW 82ND CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5247
Practice Address - Country:US
Practice Address - Phone:305-263-9728
Practice Address - Fax:305-262-9094
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8229235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist