Provider Demographics
NPI:1083021406
Name:WAX, REBECCA (MS-CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:WAX
Suffix:
Gender:F
Credentials:MS-CCC-SLP
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:BEREN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS-CCC-SLP
Mailing Address - Street 1:1488 CEDARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3807
Mailing Address - Country:US
Mailing Address - Phone:732-363-6702
Mailing Address - Fax:
Practice Address - Street 1:1488 CEDARWOOD DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3807
Practice Address - Country:US
Practice Address - Phone:732-363-6702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ14045343235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist