Provider Demographics
NPI:1922783745
Name:LACKEY, REBEKAH
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:LACKEY
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:PO BOX 1079
Mailing Address - Street 2:
Mailing Address - City:SUNRAY
Mailing Address - State:TX
Mailing Address - Zip Code:79086-1079
Mailing Address - Country:US
Mailing Address - Phone:806-382-3204
Mailing Address - Fax:
Practice Address - Street 1:101 W 10TH
Practice Address - Street 2:
Practice Address - City:SUNRAY
Practice Address - State:TX
Practice Address - Zip Code:79086-1752
Practice Address - Country:US
Practice Address - Phone:806-382-3204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX416932355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant