Provider Demographics
NPI:1790913788
Name:UTECH, REBECCA LISA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LISA
Last Name:UTECH
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 1:2253 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214
Mailing Address - Country:US
Mailing Address - Phone:716-834-7200
Mailing Address - Fax:716-831-8678
Practice Address - Street 1:2253 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2349
Practice Address - Country:US
Practice Address - Phone:716-834-7200
Practice Address - Fax:716-831-8678
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2014-07-23
Deactivation Date:2014-07-23
Deactivation Code:
Reactivation Date:2014-07-23
Provider Licenses
StateLicense IDTaxonomies
NY002259-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist