Provider Demographics
NPI:1356570790
Name:MCMILLIAN, REBECCA ELAINE (MED CCC SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ELAINE
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:MED CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W PAULK AVE
Mailing Address - Street 2:
Mailing Address - City:OPP
Mailing Address - State:AL
Mailing Address - Zip Code:36467-1630
Mailing Address - Country:US
Mailing Address - Phone:334-493-4558
Mailing Address - Fax:334-493-2837
Practice Address - Street 1:115 W PAULK AVE
Practice Address - Street 2:
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-1630
Practice Address - Country:US
Practice Address - Phone:334-493-4558
Practice Address - Fax:334-493-2837
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1132235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist