Provider Demographics
NPI:1750441697
Name:ANDERSON, REBECCA JO (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JO
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:REBECA
Other - Middle Name:JO
Other - Last Name:MCINTYRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:220 A OLD TURNPIKE RD EAST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:CT
Mailing Address - Zip Code:06752
Mailing Address - Country:US
Mailing Address - Phone:203-240-4250
Mailing Address - Fax:
Practice Address - Street 1:4BERSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-1001
Practice Address - Country:US
Practice Address - Phone:203-826-3136
Practice Address - Fax:203-775-6810
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001746235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist