Provider Demographics
NPI:1356650014
Name:COLEMAN, REBECCA D (MA, CCC-SLP, BCBA,)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:D
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP, BCBA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7608 NARROW PASS ST
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3019
Mailing Address - Country:US
Mailing Address - Phone:408-838-5718
Mailing Address - Fax:
Practice Address - Street 1:3 COMMERCIAL PL
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-3102
Practice Address - Country:US
Practice Address - Phone:210-858-9062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106306235Z00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist