Provider Demographics
NPI:1629753595
Name:CRAVEN-BRANDENBURG, REBEKAH ELLEN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ELLEN
Last Name:CRAVEN-BRANDENBURG
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:ELLEN
Other - Last Name:BRANDENBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:259 RIDGE VIEW DR APT C
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-9258
Mailing Address - Country:US
Mailing Address - Phone:336-269-0096
Mailing Address - Fax:
Practice Address - Street 1:925 10TH AVENUE DR NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3577
Practice Address - Country:US
Practice Address - Phone:336-269-0096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30001889235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist