Provider Demographics
NPI:1568530269
Name:THOMPSON, REBECCA KATHLEEN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:KATHLEEN
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12050 HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:GUSTON
Mailing Address - State:KY
Mailing Address - Zip Code:40142-7189
Mailing Address - Country:US
Mailing Address - Phone:270-899-0222
Mailing Address - Fax:
Practice Address - Street 1:12050 HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:GUSTON
Practice Address - State:KY
Practice Address - Zip Code:40142-7189
Practice Address - Country:US
Practice Address - Phone:270-899-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2852235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist