Provider Demographics
NPI:1659529956
Name:CARR, REBECCA R (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:R
Last Name:CARR
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 E DIXON RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-4114
Mailing Address - Country:US
Mailing Address - Phone:501-993-5706
Mailing Address - Fax:
Practice Address - Street 1:718 HARRIS RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-3613
Practice Address - Country:US
Practice Address - Phone:501-241-2253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR904605951235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128938721Medicaid