Provider Demographics
NPI:1073578639
Name:SAS, REBECCA L (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:L
Last Name:SAS
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 1:1809 PRECINCT LINE RD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3132
Mailing Address - Country:US
Mailing Address - Phone:817-282-7250
Mailing Address - Fax:817-282-7251
Practice Address - Street 1:1809 PRECINCT LINE RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3132
Practice Address - Country:US
Practice Address - Phone:817-282-7250
Practice Address - Fax:817-282-7251
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103580235Z00000X
OK3041235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200028580AMedicaid
OK200028580BOtherDDSD