Provider Demographics
NPI:1720309073
Name:WITTER, REBECCA L (AUD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:WITTER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:L
Other - Last Name:WANTUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:4600 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4500
Mailing Address - Country:US
Mailing Address - Phone:716-833-4488
Mailing Address - Fax:716-839-1218
Practice Address - Street 1:4600 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4500
Practice Address - Country:US
Practice Address - Phone:716-833-4488
Practice Address - Fax:716-839-1218
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400030472Medicare PIN