Provider Demographics
NPI:1306181250
Name:MASENHEIMER, REBECCA MAE (AUD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:MAE
Last Name:MASENHEIMER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16319 GRIFFIN DR E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-2081
Mailing Address - Country:US
Mailing Address - Phone:253-365-3588
Mailing Address - Fax:
Practice Address - Street 1:16319 GRIFFIN DR E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-2081
Practice Address - Country:US
Practice Address - Phone:253-365-3588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00002490231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist