Provider Demographics
NPI:1740792589
Name:FRUNDLE, REBEKAH LYNAE (SLP-CFY)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LYNAE
Last Name:FRUNDLE
Suffix:
Gender:F
Credentials:SLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64137-1747
Mailing Address - Country:US
Mailing Address - Phone:641-328-4981
Mailing Address - Fax:
Practice Address - Street 1:2415 AGNES AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64127-4129
Practice Address - Country:US
Practice Address - Phone:816-418-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017031273235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist