Provider Demographics
NPI:1861511685
Name:MARSHALL, REBECCA SHISLER (PHD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:SHISLER
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:593 ADERHOLD HALL
Practice Address - Street 2:SPEECH AND HEARING CLINIC, UNIVERSITY OF GEORGIA
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-7154
Practice Address - Country:US
Practice Address - Phone:706-583-0737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004774235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist