Provider Demographics
NPI:1558630327
Name:TAM, REBECCA Y (MS CCC- SLP)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:Y
Last Name:TAM
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 1:151 E 3RD ST APT 5C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-7485
Mailing Address - Country:US
Mailing Address - Phone:832-978-6808
Mailing Address - Fax:
Practice Address - Street 1:151 E 3RD ST APT 5C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-7485
Practice Address - Country:US
Practice Address - Phone:832-978-6808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020621235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist