Provider Demographics
NPI:1770580219
Name:SAWYER, REBECCA I (MCD, CCC, SLP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:I
Last Name:SAWYER
Suffix:
Gender:F
Credentials:MCD, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 WENDOVER DR
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-2853
Mailing Address - Country:US
Mailing Address - Phone:601-212-0870
Mailing Address - Fax:601-362-0870
Practice Address - Street 1:207 W JACKSON ST STE 2
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2355
Practice Address - Country:US
Practice Address - Phone:601-212-0870
Practice Address - Fax:601-362-0870
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS0126235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09013963Medicaid
MS00014339Medicaid