Provider Demographics
NPI:1619347275
Name:WHITE, REBEKAH DIANNE DEGARMO
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:DIANNE DEGARMO
Last Name:WHITE
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 1:922 CRESTMONT WAY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5061
Mailing Address - Country:US
Mailing Address - Phone:864-421-4414
Mailing Address - Fax:
Practice Address - Street 1:1230 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2413
Practice Address - Country:US
Practice Address - Phone:864-438-0990
Practice Address - Fax:864-478-8383
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5744235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist