Provider Demographics
NPI:1780375121
Name:HOUGHTON, REBECCA FAGEN
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:FAGEN
Last Name:HOUGHTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 N STONE MILL RD STE B
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-9320
Mailing Address - Country:US
Mailing Address - Phone:812-929-2193
Mailing Address - Fax:
Practice Address - Street 1:501 S MADISON ST STE 105
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2452
Practice Address - Country:US
Practice Address - Phone:812-929-2193
Practice Address - Fax:888-789-8394
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program