Provider Demographics
NPI:1497486773
Name:RETHANS, ROBERT (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:RETHANS
Suffix:
Gender:M
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 1:2889 SWEETWATER FLS
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-1806
Mailing Address - Country:US
Mailing Address - Phone:530-591-7433
Mailing Address - Fax:
Practice Address - Street 1:2889 SWEETWATER FLS
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-1806
Practice Address - Country:US
Practice Address - Phone:530-591-7433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-18
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22094235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist