Provider Demographics
NPI:1255588802
Name:MILES, REBECCA DENISE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:DENISE
Last Name:MILES
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 1:8715 HOLMES RD
Mailing Address - Street 2:STUDENT SERVICES DEPT.
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-2802
Mailing Address - Country:US
Mailing Address - Phone:816-349-3308
Mailing Address - Fax:
Practice Address - Street 1:8715 HOLMES RD
Practice Address - Street 2:STUDENT SERVICES DEPT.
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-2802
Practice Address - Country:US
Practice Address - Phone:816-349-3308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2011-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008022580174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist