Provider Demographics
NPI:1538309158
Name:CRAIG, REBECCA E (MSCCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:E
Last Name:CRAIG
Suffix:
Gender:F
Credentials:MSCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 S ISABELLA ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IL
Mailing Address - Zip Code:61727-2376
Mailing Address - Country:US
Mailing Address - Phone:217-935-4835
Mailing Address - Fax:
Practice Address - Street 1:203 S SHERMAN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727-2527
Practice Address - Country:US
Practice Address - Phone:217-853-5388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-22
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008426235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist