Provider Demographics
NPI:1134768492
Name:KRUISE, REBECCA LYNN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:KRUISE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:REBECA
Other - Middle Name:LYNN
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:202 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BURNHAM
Mailing Address - State:PA
Mailing Address - Zip Code:17009-1616
Mailing Address - Country:US
Mailing Address - Phone:717-559-3400
Mailing Address - Fax:833-561-2553
Practice Address - Street 1:202 5TH AVE
Practice Address - Street 2:
Practice Address - City:BURNHAM
Practice Address - State:PA
Practice Address - Zip Code:17009-1616
Practice Address - Country:US
Practice Address - Phone:484-663-3693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL015584235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist