Provider Demographics
NPI:1770139198
Name:KLOSOWSKI, REBECCA LYNN (HIS)
Entity type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:LYNN
Last Name:KLOSOWSKI
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:MISS
Other - First Name:BECKY
Other - Middle Name:LYNN
Other - Last Name:KLOSOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HIS
Mailing Address - Street 1:1000 HENDERSON ST APT 346
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-4567
Mailing Address - Country:US
Mailing Address - Phone:815-793-2103
Mailing Address - Fax:
Practice Address - Street 1:2000 E LAMAR BLVD STE 624
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-7346
Practice Address - Country:US
Practice Address - Phone:469-251-0577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80582237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist