Provider Demographics
NPI:1790328060
Name:BREWER, REBECCA DORNAK (MA CF-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DORNAK
Last Name:BREWER
Suffix:
Gender:F
Credentials:MA CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6623 CALLAGHAN RD APT 1005
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5107
Mailing Address - Country:US
Mailing Address - Phone:979-320-7778
Mailing Address - Fax:
Practice Address - Street 1:696 FM 99
Practice Address - Street 2:
Practice Address - City:KARNES CITY
Practice Address - State:TX
Practice Address - Zip Code:78118-5009
Practice Address - Country:US
Practice Address - Phone:830-780-3944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-19
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115569235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist