Provider Demographics
NPI:1346585106
Name:HENDRICKSON, REBECCA R (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:R
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
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Other - First Name:
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Mailing Address - Street 1:PO BOX 1376
Mailing Address - Street 2:1415 E. KINCAID ST
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-1376
Mailing Address - Country:US
Mailing Address - Phone:360-814-2699
Mailing Address - Fax:360-814-5828
Practice Address - Street 1:1415 E KINCAID ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4126
Practice Address - Country:US
Practice Address - Phone:360-814-2699
Practice Address - Fax:360-814-5828
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WASLP.LL.00004138235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist