Healthcare Provider Details

I. General information

NPI: 1477469922
Provider Name (Legal Business Name): REBECCA GREEN M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W VALENCIA DR
FULLERTON CA
92833-3998
US

IV. Provider business mailing address

6220 E SHENANDOAH AVE
ORANGE CA
92867-2411
US

V. Phone/Fax

Practice location:
  • Phone: 714-447-7400
  • Fax:
Mailing address:
  • Phone: 714-396-8808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number19287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: