Provider Demographics
NPI:1265751473
Name:TRAMMEL, REBECCA J (MS, SLP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:J
Last Name:TRAMMEL
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-1246
Mailing Address - Country:US
Mailing Address - Phone:618-967-2084
Mailing Address - Fax:
Practice Address - Street 1:615 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-1246
Practice Address - Country:US
Practice Address - Phone:618-967-2084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146001148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist