Provider Demographics
NPI:1790938397
Name:COPELAND, REBECCA LEA (MA CCC/SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEA
Last Name:COPELAND
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 PENNINGTON LN
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-8529
Mailing Address - Country:US
Mailing Address - Phone:606-475-9425
Mailing Address - Fax:
Practice Address - Street 1:556 PENNINGTON LN
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-8529
Practice Address - Country:US
Practice Address - Phone:606-475-9425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2466235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist