Healthcare Provider Details

I. General information

NPI: 1750441697
Provider Name (Legal Business Name): REBECCA JO ANDERSON MS CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECA JO MCINTYRE MS CCC SLP

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4BERSHIRE BLVD
BETHEL CT
06801-1001
US

IV. Provider business mailing address

220 A OLD TURNPIKE RD EAST
BRIDGEWATER CT
06752
US

V. Phone/Fax

Practice location:
  • Phone: 203-826-3136
  • Fax: 203-775-6810
Mailing address:
  • Phone: 203-240-4250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number001746
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: