Provider Demographics
NPI:1982729273
Name:BURGAN, REBECCA A (MACCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:BURGAN
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:A
Other - Last Name:SIECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACCC-SLP
Mailing Address - Street 1:5259 NEWELL CIR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45440-2806
Mailing Address - Country:US
Mailing Address - Phone:937-433-5779
Mailing Address - Fax:
Practice Address - Street 1:5259 NEWELL CIR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45440-2806
Practice Address - Country:US
Practice Address - Phone:937-433-5779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 3305235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist