Provider Demographics
NPI:1538474127
Name:KHAYUM, REBECCA MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:KHAYUM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 BROOKLYN DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-9038
Mailing Address - Country:US
Mailing Address - Phone:773-354-7539
Mailing Address - Fax:773-904-2361
Practice Address - Street 1:634 BROOKLYN DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-9038
Practice Address - Country:US
Practice Address - Phone:773-354-7539
Practice Address - Fax:773-904-2361
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-08
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008945235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist