Provider Demographics
NPI:1770625352
Name:PAGE, REBEKAH JOHNSON (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:JOHNSON
Last Name:PAGE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2101 SARDIS RD N
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7711
Mailing Address - Country:US
Mailing Address - Phone:704-845-6134
Mailing Address - Fax:704-845-8024
Practice Address - Street 1:2101 SARDIS RD N
Practice Address - Street 2:SUITE 112
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-7711
Practice Address - Country:US
Practice Address - Phone:704-845-6134
Practice Address - Fax:704-845-8024
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9849903235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist