Provider Demographics
NPI:1568592160
Name:REBAL, ANNASTATIA (AUD)
Entity Type:Individual
Prefix:DR
First Name:ANNASTATIA
Middle Name:
Last Name:REBAL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 ESTHER ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-2586
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 10TH AVE
Practice Address - Street 2:P.O. 5637
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2389
Practice Address - Country:US
Practice Address - Phone:319-338-6043
Practice Address - Fax:319-338-7739
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00552231H00000X
IA00833231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0493155Medicaid