Provider Demographics
NPI:1851583140
Name:SANTOS, REBECCA ROSE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ROSE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 CAMBRIDGE STREET, POB 3RD FLOOR
Mailing Address - Street 2:MGH, DEPT OF SPEECH, LANGUAGE AND SWALLOWING
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-724-4369
Mailing Address - Fax:617-724-0771
Practice Address - Street 1:275 CAMBRIDGE STREET, POB 3RD FLOOR
Practice Address - Street 2:MGH, DEPT OF SPEECH, LANGUAGE AND SWALLOWING
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-724-4369
Practice Address - Fax:617-724-0771
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6163235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist