MEDICARE: REBECCA CANADY M.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	5309	NC

General Provider Information

NPI Number	:	1548774219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA CANADY M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	2848 WHEELOCK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-3318
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11535 CARMEL COMMONS BLVD STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-5314
Country	:	US
Telephone Number	:	704-541-3737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2017
Last Update Date	:	11/16/2017

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