Provider Demographics
NPI:1013713643
Name:KOONTZ, REBECCA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KOONTZ
Suffix:
Gender:
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 1:10824 OLD MILL RD STE 10-1
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2642
Mailing Address - Country:US
Mailing Address - Phone:402-680-1823
Mailing Address - Fax:
Practice Address - Street 1:10824 OLD MILL RD STE 10-1
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2642
Practice Address - Country:US
Practice Address - Phone:402-680-1823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist