Healthcare Provider Details

I. General information

NPI: 1992802516
Provider Name (Legal Business Name): REBEKAH L. DONNELLY AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBEKAH L BARNETT MCD

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 04/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 FAIRFAX ST
CARLYLE IL
62231-1809
US

IV. Provider business mailing address

811 FAIRFAX ST
CARLYLE IL
62231-1809
US

V. Phone/Fax

Practice location:
  • Phone: 618-594-4966
  • Fax: 618-205-5067
Mailing address:
  • Phone: 618-594-4966
  • Fax: 618-205-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147-000882
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number109738
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: