Provider Demographics
NPI:1912299439
Name:COURSEY, REBEKAH ANN (BSSLPA)
Entity Type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:ANN
Last Name:COURSEY
Suffix:
Gender:F
Credentials:BSSLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 W CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921-3905
Mailing Address - Country:US
Mailing Address - Phone:479-632-0258
Mailing Address - Fax:479-632-8061
Practice Address - Street 1:14 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921-3905
Practice Address - Country:US
Practice Address - Phone:479-632-0258
Practice Address - Fax:479-632-8061
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR10009235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR186183721Medicaid