Provider Demographics
NPI:1205127461
Name:HOUSTON, REBECCA LEWIS
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LEWIS
Last Name:HOUSTON
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 1:420 SAINT ANDREWS DR
Mailing Address - Street 2:B2 #4
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-2511
Mailing Address - Country:US
Mailing Address - Phone:662-902-2331
Mailing Address - Fax:
Practice Address - Street 1:420 SAINT ANDREWS DR
Practice Address - Street 2:B2#4
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-2511
Practice Address - Country:US
Practice Address - Phone:662-902-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3547235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist