Provider Demographics
NPI:1497122576
Name:DELBRIDGE, REBECCA (MS ED)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:DELBRIDGE
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 GARTH CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5751
Mailing Address - Country:US
Mailing Address - Phone:949-616-6262
Mailing Address - Fax:
Practice Address - Street 1:1200 GARTH CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5751
Practice Address - Country:US
Practice Address - Phone:949-616-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007999235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350179022011OtherMEDICAL ASSISTANCE SERVICES