Provider Demographics
NPI:1750670311
Name:MILLSAP, REBECCA K (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:K
Last Name:MILLSAP
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 1:3140 CAHABA HEIGHTS RD STE 102
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-5243
Mailing Address - Country:US
Mailing Address - Phone:205-969-8080
Mailing Address - Fax:205-969-4884
Practice Address - Street 1:3140 CAHABA HEIGHTS RD STE 102
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-5243
Practice Address - Country:US
Practice Address - Phone:205-969-8080
Practice Address - Fax:205-969-4884
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist