Provider Demographics
NPI:1285196154
Name:ATENCIO, REBEKAH LEE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LEE
Last Name:ATENCIO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:ANNE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5342 GUINEA RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-3935
Mailing Address - Country:US
Mailing Address - Phone:602-881-8525
Mailing Address - Fax:
Practice Address - Street 1:5342 GUINEA RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-3935
Practice Address - Country:US
Practice Address - Phone:480-382-6618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2203001029235Z00000X
MD11668235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14378360OtherASHA
VA2203001029OtherVIRGINIADEPARTMENTOFHEALTHPROFESSIONS
MD11668OtherMARYLANDDEPARTMENTOFHEALTH