Healthcare Provider Details

I. General information

NPI: 1013567809
Provider Name (Legal Business Name): REBEKAH PATTERSON WALDRUM SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 OSLO CIR
BIRMINGHAM AL
35211-5965
US

IV. Provider business mailing address

100 OSLO CIR
BIRMINGHAM AL
35211-5965
US

V. Phone/Fax

Practice location:
  • Phone: 205-944-3921
  • Fax: 205-413-4914
Mailing address:
  • Phone: 205-944-3921
  • Fax: 205-413-4914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4547
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: