Doctor Name: | REBECCA SUSAN BLACK |
NPI Number: | 1134344856 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A., CCC-SLP |
License Number: | 22004280A |
Business Practice Address: | 269 Glendale Ct Avon, IN - 461237143 |
Business Phone Number: | 3174170057 |
Business Fax Number: | 3172724049 |
Mailing Address: | 269 Glendale Ct, AVON |
State: | IN |
Postal Code: | 461237143 |
Phone Number: | 3174170057 |
Fax Number: | 3172724049 |
NPI Enumeration Date: | 04/16/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 22004280A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |