Provider Demographics
NPI:1073078663
Name:MURDOCK, REBECCA ELISE (CF-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ELISE
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-1423
Mailing Address - Country:US
Mailing Address - Phone:703-350-9644
Mailing Address - Fax:
Practice Address - Street 1:4870 HAYGOOD RD STE 102
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5300
Practice Address - Country:US
Practice Address - Phone:757-499-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000224235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist