Provider Demographics
NPI:1558698977
Name:GARNICK, REBECCA L (MS/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:GARNICK
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 1:131 FORT BEECH DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:KY
Mailing Address - Zip Code:41071-2860
Mailing Address - Country:US
Mailing Address - Phone:859-757-8648
Mailing Address - Fax:
Practice Address - Street 1:425 GARRARD ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-2562
Practice Address - Country:US
Practice Address - Phone:859-581-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2009-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1330235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist