MEDICARE: REBECCA K MILLSAP 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	6010	LA

General Provider Information

NPI Number	:	1750670311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA K MILLSAP M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	3140 CAHABA HEIGHTS RD STE 102
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35243-5243
Country	:	US
Telephone Number	:	205-969-8080
Fax Number	:	205-969-4884

Provider Business Practice Location Address
First Line	:	3140 CAHABA HEIGHTS RD STE 102
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35243-5243
Country	:	US
Telephone Number	:	205-969-8080
Fax Number	:	205-969-4884

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

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	03/17/2018

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