Provider Demographics
NPI:1578138160
Name:SMITH, REBECCA ALICE (CDCA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ALICE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8492 SLAGLE RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:OH
Mailing Address - Zip Code:44288-9767
Mailing Address - Country:US
Mailing Address - Phone:330-993-7115
Mailing Address - Fax:
Practice Address - Street 1:3975 KENNETH DR
Practice Address - Street 2:
Practice Address - City:ROOTSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44272-9252
Practice Address - Country:US
Practice Address - Phone:330-850-5141
Practice Address - Fax:330-850-5349
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist