MEDICARE: MS. REBECCA LEE IWANCZYK M.A.

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
2	235Z00000X	Speech-Language Pathologist	3248	TN

General Provider Information

NPI Number	:	1881880177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REBECCA LEE IWANCZYK M.A.

Provider Business Mailing Address
First Line	:	5819 WINDING LN STE 101
Second Line	:
City	:	HIXSON
State	:	TN
Zip	:	37343-4067
Country	:	US
Telephone Number	:	423-877-5042
Fax Number	:	423-877-5046

Provider Business Practice Location Address
First Line	:	5819 WINDING LN STE 101
Second Line	:
City	:	HIXSON
State	:	TN
Zip	:	37343-4067
Country	:	US
Telephone Number	:	423-877-5042
Fax Number	:	423-877-5046

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

Provider Enumeration Date	:	09/20/2007
Last Update Date	:	02/16/2022

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Directions to “ MS. REBECCA LEE IWANCZYK M.A.” Practice Location

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