Provider Demographics
NPI:1932465275
Name:WHITE, REBECCA ANN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANN
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:STEPHENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:93 NEW ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-3803
Mailing Address - Country:US
Mailing Address - Phone:860-966-5727
Mailing Address - Fax:
Practice Address - Street 1:8 CHURCH ST S
Practice Address - Street 2:SUITE B
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5354
Practice Address - Country:US
Practice Address - Phone:203-505-5723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist