Provider Demographics
NPI:1023237815
Name:WESSON, REBECCA BASHA (MS,CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:BASHA
Last Name:WESSON
Suffix:
Gender:F
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 1:9134 NORTHSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEONA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93551-7105
Mailing Address - Country:US
Mailing Address - Phone:818-517-7057
Mailing Address - Fax:
Practice Address - Street 1:23504 LYONS AVE
Practice Address - Street 2:404
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2500
Practice Address - Country:US
Practice Address - Phone:818-517-7057
Practice Address - Fax:661-257-8954
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP13777235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist