Provider Demographics
NPI:1083142400
Name:DENHAM, REBECCA BROCKHAUS (MA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:BROCKHAUS
Last Name:DENHAM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 PERKINS RD APT 2114
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-5306
Mailing Address - Country:US
Mailing Address - Phone:225-721-1810
Mailing Address - Fax:
Practice Address - Street 1:9150 BEREFORD DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2403
Practice Address - Country:US
Practice Address - Phone:225-960-7689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-30
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2204235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist