Provider Demographics
NPI:1104835339
Name:FOGEL, REBECCA (AUDIOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:FOGEL
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7150 N. PRES. GEORGE BUSH HWY
Mailing Address - Street 2:STE. 202
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044
Mailing Address - Country:US
Mailing Address - Phone:972-414-0408
Mailing Address - Fax:972-495-9084
Practice Address - Street 1:7150 N. PRES. GEORGE BUSH HWY
Practice Address - Street 2:STE. 202
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044
Practice Address - Country:US
Practice Address - Phone:972-414-0408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80206231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX205689701Medicaid
IL1470006471Medicaid
TXP00766557Medicare PIN
TX8L17928Medicare PIN
IL387350Medicare ID - Type Unspecified