Provider Demographics
NPI:1376363986
Name:TAKESUE, REBECCA PADILLA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:PADILLA
Last Name:TAKESUE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19886 GRACE HAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-6543
Mailing Address - Country:US
Mailing Address - Phone:619-246-2065
Mailing Address - Fax:
Practice Address - Street 1:19886 GRACE HAVEN WAY
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-6543
Practice Address - Country:US
Practice Address - Phone:619-246-2065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32881235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist