Provider Demographics
NPI:1578591269
Name:CLICK, REBECCA DAYE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:DAYE
Last Name:CLICK
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 1:159 STAFFORD RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-4209
Mailing Address - Country:US
Mailing Address - Phone:423-246-4600
Mailing Address - Fax:
Practice Address - Street 1:404 REVERE ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3671
Practice Address - Country:US
Practice Address - Phone:423-246-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP0000003151235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4109879OtherBLUECROSS BLUESHIELD
VA446506Medicare ID - Type Unspecified