Provider Demographics
NPI:1053655944
Name:RYAN, REBECCA SUE (MS/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:RYAN
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 1:6309 GRANBY ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-4567
Mailing Address - Country:US
Mailing Address - Phone:910-264-1507
Mailing Address - Fax:
Practice Address - Street 1:631 JUNCTION CREEK DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2296
Practice Address - Country:US
Practice Address - Phone:910-442-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2598235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist