Healthcare Provider Details

I. General information

NPI: 1003335795
Provider Name (Legal Business Name): REBECCA ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 09/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 NW 10TH AVE STE 104
BOCA RATON FL
33486-1344
US

IV. Provider business mailing address

1500 NW 10TH AVE STE 104
BOCA RATON FL
33486-1344
US

V. Phone/Fax

Practice location:
  • Phone: 561-807-7873
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA1933
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: