Provider Demographics
NPI:1649289729
Name:DOE, NANCY REBECCA (MS/CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:REBECCA
Last Name:DOE
Suffix:
Gender:F
Credentials:MS/CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 HIGHLAND CIR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-9243
Mailing Address - Country:US
Mailing Address - Phone:717-712-9566
Mailing Address - Fax:
Practice Address - Street 1:2225 HIGHLAND CIR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9243
Practice Address - Country:US
Practice Address - Phone:717-712-9566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009114235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist