Provider Demographics
NPI:1467687814
Name:TEW, REBECCA DIANE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DIANE
Last Name:TEW
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 GRANT ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4734
Mailing Address - Country:US
Mailing Address - Phone:703-904-8334
Mailing Address - Fax:703-904-8334
Practice Address - Street 1:626 GRANT ST
Practice Address - Street 2:SUITE K
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4734
Practice Address - Country:US
Practice Address - Phone:703-904-8334
Practice Address - Fax:703-904-8334
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003614235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist