Provider Demographics
NPI:1710401633
Name:JENNINGS, REBECCA J (MT-BC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:J
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MT-BC
Mailing Address - Street 1:1015 GRAND AVE APT 3B
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-3659
Mailing Address - Country:US
Mailing Address - Phone:515-320-4825
Mailing Address - Fax:
Practice Address - Street 1:501 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-3913
Practice Address - Country:US
Practice Address - Phone:712-262-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist