Provider Demographics
NPI:1972272581
Name:BRITTAIN, REBEKAH ANNE
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ANNE
Last Name:BRITTAIN
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 1:2929 RYAN AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-3443
Mailing Address - Country:US
Mailing Address - Phone:417-339-7573
Mailing Address - Fax:
Practice Address - Street 1:512 PEACH ST
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-3119
Practice Address - Country:US
Practice Address - Phone:817-297-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112951235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist