Provider Demographics
NPI:1457847857
Name:MILLER, REBECCA BOURQUE (CCC-SLP, CLC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:BOURQUE
Last Name:MILLER
Suffix:
Gender:F
Credentials:CCC-SLP, CLC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MARIE
Other - Last Name:BOURQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP-CFY
Mailing Address - Street 1:1344 GENTLE WIND DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70820-2919
Mailing Address - Country:US
Mailing Address - Phone:225-276-0347
Mailing Address - Fax:
Practice Address - Street 1:8300 CONSTANTIN BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3489
Practice Address - Country:US
Practice Address - Phone:225-374-1520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114646235Z00000X
LA8312235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty