Provider Demographics
NPI:1073839106
Name:PENDLETON, REBECCA LOU (SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LOU
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-3911
Mailing Address - Country:US
Mailing Address - Phone:405-762-1269
Mailing Address - Fax:
Practice Address - Street 1:1707 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-3911
Practice Address - Country:US
Practice Address - Phone:405-762-1269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK435235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist