Provider Demographics
NPI:1255521936
Name:GIBSON, REBECCA J (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:J
Last Name:GIBSON
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 1:514 TURKEY HILL DR
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021-8717
Mailing Address - Country:US
Mailing Address - Phone:336-983-4933
Mailing Address - Fax:
Practice Address - Street 1:514 TURKEY HILL DR
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-8717
Practice Address - Country:US
Practice Address - Phone:336-983-4933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6718235Z00000X
VA2202001566235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist