Provider Demographics
NPI:1982702668
Name:BERQUIST, REBECCA B (MS CCC/A)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:B
Last Name:BERQUIST
Suffix:
Gender:F
Credentials:MS CCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 OLYMPIA DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1855
Mailing Address - Country:US
Mailing Address - Phone:972-539-7821
Mailing Address - Fax:972-539-7849
Practice Address - Street 1:2301 OLYMPIA DR.
Practice Address - Street 2:SUITE 300
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1855
Practice Address - Country:US
Practice Address - Phone:972-539-7821
Practice Address - Fax:972-539-7849
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50360231H00000X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No332S00000XSuppliersHearing Aid Equipment