Provider Demographics
NPI:1649509092
Name:RODRICKS, REBECCA BOYLE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:BOYLE
Last Name:RODRICKS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:BOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-1711
Mailing Address - Country:US
Mailing Address - Phone:917-589-0389
Mailing Address - Fax:
Practice Address - Street 1:35 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-1711
Practice Address - Country:US
Practice Address - Phone:917-589-0389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013103-1235Z00000X
CT003924235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist