Provider Demographics
NPI:1073217287
Name:DIEKELMAN, REBECCA ANN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:DIEKELMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6496 GEMSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5523
Mailing Address - Country:US
Mailing Address - Phone:719-242-7316
Mailing Address - Fax:
Practice Address - Street 1:6496 GEMSTONE WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5523
Practice Address - Country:US
Practice Address - Phone:719-242-7316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0004524235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist