Healthcare Provider Details

I. General information

NPI: 1992545867
Provider Name (Legal Business Name): REBEKAH SLOAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 1ST ST. W
MOUNT VERNON IA
52413
US

IV. Provider business mailing address

1680 QUAIL HOLW NE APT 15C
CEDAR RAPIDS IA
52402-5868
US

V. Phone/Fax

Practice location:
  • Phone: 319-440-4280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number139404
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: