Provider Demographics
NPI:1104857135
Name:BLAHA, REBECCA JOSEPH (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JOSEPH
Last Name:BLAHA
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8380 OLD YORK RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1539
Mailing Address - Country:US
Mailing Address - Phone:215-886-8660
Mailing Address - Fax:215-886-8856
Practice Address - Street 1:8380 OLD YORK RD
Practice Address - Street 2:SUITE 120
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1539
Practice Address - Country:US
Practice Address - Phone:215-886-8660
Practice Address - Fax:215-886-8856
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE02000150237600000X
PAAT006180237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE019576W44Medicare PIN