Provider Demographics
NPI:1336395938
Name:THORLEY, REBECCA L (MACCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:L
Last Name:THORLEY
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30210 MESA VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-3192
Mailing Address - Country:US
Mailing Address - Phone:281-419-5153
Mailing Address - Fax:
Practice Address - Street 1:230 SPRING HILL DR
Practice Address - Street 2:SUITE 305
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-2381
Practice Address - Country:US
Practice Address - Phone:281-292-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102613235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist