Provider Demographics
NPI:1821422437
Name:DALTON, REBECCA L (MS)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:L
Last Name:DALTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 COVERED BRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2101
Mailing Address - Country:US
Mailing Address - Phone:757-619-7411
Mailing Address - Fax:
Practice Address - Street 1:2205 COVERED BRIDGE WAY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2101
Practice Address - Country:US
Practice Address - Phone:757-619-7411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007167235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist