Provider Demographics
NPI:1669963625
Name:ENGLUND, REBECCA SONIA (MA, CCC/SLP)
Entity type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:SONIA
Last Name:ENGLUND
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 DELAWARE AVE APT 2G
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-3554
Mailing Address - Country:US
Mailing Address - Phone:518-763-2743
Mailing Address - Fax:
Practice Address - Street 1:113 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-1349
Practice Address - Country:US
Practice Address - Phone:716-923-1534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY029269235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program