Provider Demographics
NPI:1639214794
Name:CARR, REBECCA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:CARR
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:ZEITLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22899 WEATHER VANE CT
Mailing Address - Street 2:
Mailing Address - City:MATTAWAN
Mailing Address - State:MI
Mailing Address - Zip Code:49071-8501
Mailing Address - Country:US
Mailing Address - Phone:612-226-4803
Mailing Address - Fax:
Practice Address - Street 1:22899 WEATHER VANE CT
Practice Address - Street 2:
Practice Address - City:MATTAWAN
Practice Address - State:MI
Practice Address - Zip Code:49071
Practice Address - Country:US
Practice Address - Phone:612-226-4803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8038235Z00000X
MI235Z00000X
MI7101005600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist