Provider Demographics
NPI:1831437805
Name:PENTES, REBECCA (MCD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:PENTES
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:P
Other - Last Name:D'AMICO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MCD
Mailing Address - Street 1:306 W JUDGE PEREZ DR
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-4904
Mailing Address - Country:US
Mailing Address - Phone:504-309-6270
Mailing Address - Fax:
Practice Address - Street 1:306 W JUDGE PEREZ DR
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-4904
Practice Address - Country:US
Practice Address - Phone:504-309-6270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6782235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist