Provider Demographics
NPI:1366863821
Name:SPRINGER, REBECCA (MA CCC-SP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SPRINGER
Suffix:
Gender:F
Credentials:MA CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 VICKI LN
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4558
Mailing Address - Country:US
Mailing Address - Phone:402-371-2303
Mailing Address - Fax:402-371-1152
Practice Address - Street 1:1900 VICKI LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4558
Practice Address - Country:US
Practice Address - Phone:402-371-2303
Practice Address - Fax:402-371-1152
Is Sole Proprietor?:No
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1491235Z00000X
CA4244235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100254036-00Medicaid
NE28-5101Medicare UPIN