Provider Demographics
NPI:1114126125
Name:MASSO, REBECCA (SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MASSO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CALLE PETUNIA
Mailing Address - Street 2:CIUDAD JARDIN
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-2243
Mailing Address - Country:US
Mailing Address - Phone:787-776-2642
Mailing Address - Fax:
Practice Address - Street 1:135 AVE. ROOSEVELT
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-753-9082
Practice Address - Fax:787-763-9209
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR506235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist