Provider Demographics
NPI:1750446811
Name:DOLAN, REBECCA JEANNE (AUD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEANNE
Last Name:DOLAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:JEANNE
Other - Last Name:LUEDDEKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:3555 ALAMEDA DE LAS PUGLAS
Mailing Address - Street 2:STE. 100
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025
Mailing Address - Country:US
Mailing Address - Phone:650-854-1980
Mailing Address - Fax:650-854-1987
Practice Address - Street 1:3555 ALMEDA DE LAS PULGAS
Practice Address - Street 2:STE. 100
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025
Practice Address - Country:US
Practice Address - Phone:650-854-1980
Practice Address - Fax:650-854-1987
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2242237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABU167YOtherMEDICARE PTAN FOR PENINSULA MEDICAL CLINIC
CAZZZ30891ZMedicare ID - Type Unspecified
CAYYY20677YMedicare PIN