Provider Demographics
NPI:1356631576
Name:DOIDGE, REBECCA JO (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JO
Last Name:DOIDGE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1216
Mailing Address - Country:US
Mailing Address - Phone:719-369-0565
Mailing Address - Fax:719-647-0626
Practice Address - Street 1:2931 8TH AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1216
Practice Address - Country:US
Practice Address - Phone:719-369-0565
Practice Address - Fax:719-647-0626
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist