Provider Demographics
NPI:1578972675
Name:ARCHER, REBECCA JANE
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:JANE
Last Name:ARCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2656 W BROADWAY BLVD
Mailing Address - Street 2:#8204
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-8425
Mailing Address - Country:US
Mailing Address - Phone:210-347-5675
Mailing Address - Fax:
Practice Address - Street 1:2802 W ANKLAM RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-1724
Practice Address - Country:US
Practice Address - Phone:520-225-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP8930235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist