Healthcare Provider Details

I. General information

NPI: 1043649072
Provider Name (Legal Business Name): REBECCA CLARA ESKRIDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 C EAST PORTIER CT.
MOBILE AL
36607
US

IV. Provider business mailing address

200 C EAST PORTIER CT.
MOBILE AL
36607
US

V. Phone/Fax

Practice location:
  • Phone: 251-605-1334
  • Fax:
Mailing address:
  • Phone: 251-605-1334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2929
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: