Provider Demographics
NPI:1427186378
Name:VAN ORDEN, REBEKAH LOUISE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:LOUISE
Last Name:VAN ORDEN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 S COAST HWY
Mailing Address - Street 2:STE 103
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6455
Mailing Address - Country:US
Mailing Address - Phone:760-529-4975
Mailing Address - Fax:
Practice Address - Street 1:3355 MISSION AVE STE 103
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-1326
Practice Address - Country:US
Practice Address - Phone:760-529-4975
Practice Address - Fax:760-529-4761
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P7981235Z00000X
CASP17061235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR160476721Medicaid