Provider Demographics
NPI:1982890133
Name:LULAI, REBECCA MARY LUDEWIG (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARY LUDEWIG
Last Name:LULAI
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MARY
Other - Last Name:LUDEWIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:164 PILLSBURY DR SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0279
Mailing Address - Country:US
Mailing Address - Phone:612-624-9314
Mailing Address - Fax:612-624-7586
Practice Address - Street 1:164 PILLSBURY DR SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0279
Practice Address - Country:US
Practice Address - Phone:612-624-9314
Practice Address - Fax:612-624-7586
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6294235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist