Provider Demographics
NPI:1639337785
Name:HAEMMERLE, REBECCA A (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:HAEMMERLE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 MARKETING PL STE B
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-9308
Mailing Address - Country:US
Mailing Address - Phone:614-492-2550
Mailing Address - Fax:
Practice Address - Street 1:4400 MARKETING PL STE B
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-9308
Practice Address - Country:US
Practice Address - Phone:614-492-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.9345235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0028740Medicaid
OH9290211Medicare PIN