Provider Demographics
NPI:1275107773
Name:LOVAAS, REBECCA SUE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:LOVAAS
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 1:5 BREEZY POINT RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-3669
Mailing Address - Country:US
Mailing Address - Phone:608-346-0141
Mailing Address - Fax:
Practice Address - Street 1:5 BREEZY POINT RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-3669
Practice Address - Country:US
Practice Address - Phone:608-346-0141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3012-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist