Provider Demographics
NPI:1245793033
Name:AMBLO, REBECCA (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:AMBLO
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VT
Mailing Address - Zip Code:05454-9624
Mailing Address - Country:US
Mailing Address - Phone:802-524-9401
Mailing Address - Fax:
Practice Address - Street 1:3 HOME HEALTH CIR
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-9737
Practice Address - Country:US
Practice Address - Phone:802-527-7531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist