Provider Demographics
NPI:1487820023
Name:FAUST, REBECCA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:FAUST
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6349 TENDERFOOT DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-7436
Mailing Address - Country:US
Mailing Address - Phone:719-338-3886
Mailing Address - Fax:
Practice Address - Street 1:2512 LOVELAND AVE
Practice Address - Street 2:APT. 3
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-2040
Practice Address - Country:US
Practice Address - Phone:814-440-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-04
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8959235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist