Provider Demographics
NPI:1093924672
Name:WANTMAN, REBECCA QUICK (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:QUICK
Last Name:WANTMAN
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 1:508 FOSS AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2305
Mailing Address - Country:US
Mailing Address - Phone:610-284-2492
Mailing Address - Fax:
Practice Address - Street 1:508 FOSS AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-2305
Practice Address - Country:US
Practice Address - Phone:610-284-2492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005336L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist