Provider Demographics
NPI:1558818633
Name:SMITH, REBECCA BRYSON (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:BRYSON
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:BRYSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:516 W BIJOU ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-1311
Mailing Address - Country:US
Mailing Address - Phone:719-633-9114
Mailing Address - Fax:719-329-0495
Practice Address - Street 1:516 W BIJOU ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1311
Practice Address - Country:US
Practice Address - Phone:719-633-9114
Practice Address - Fax:719-329-0495
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSLP.0000175235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist