Provider Demographics
NPI:1689723132
Name:BECKSTROM, REBECCA L (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:BECKSTROM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6924 HYDE PARK DR
Mailing Address - Street 2:APT #320
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-2269
Mailing Address - Country:US
Mailing Address - Phone:619-692-0622
Mailing Address - Fax:619-692-6044
Practice Address - Street 1:7801 MISSION CENTER CT
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1313
Practice Address - Country:US
Practice Address - Phone:619-692-0622
Practice Address - Fax:619-692-0644
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP14620235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist