Provider Demographics
NPI:1457838625
Name:TUCKER, REBECCA (PEER SPECIALIST)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PEER SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13110 TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5122
Mailing Address - Country:US
Mailing Address - Phone:216-288-5060
Mailing Address - Fax:
Practice Address - Street 1:13110 TYLER AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5122
Practice Address - Country:US
Practice Address - Phone:216-288-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist