Provider Demographics
NPI:1780190868
Name:BROUGHTON, REBEKKAH C
Entity Type:Individual
Prefix:
First Name:REBEKKAH
Middle Name:C
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 STERKEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1508
Mailing Address - Country:US
Mailing Address - Phone:419-571-2973
Mailing Address - Fax:
Practice Address - Street 1:270 STERKEL BLVD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1508
Practice Address - Country:US
Practice Address - Phone:419-571-2973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician