Healthcare Provider Details

I. General information

NPI: 1184012817
Provider Name (Legal Business Name): REBECCA HENRY M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 08/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11602 LAKE UNDERHILL RD STE 129
ORLANDO FL
32825-4460
US

IV. Provider business mailing address

11602 LAKE UNDERHILL RD STE 129
ORLANDO FL
32825-4460
US

V. Phone/Fax

Practice location:
  • Phone: 407-384-2767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ6981
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: