Healthcare Provider Details

I. General information

NPI: 1295664316
Provider Name (Legal Business Name): REBEKAH KANABLE CCC-SLP
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12050 HANCOCK ST SE
BECKER MN
55308-9526
US

IV. Provider business mailing address

14451 HUBER AVE NW
ANNANDALE MN
55302-2214
US

V. Phone/Fax

Practice location:
  • Phone: 763-261-6330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number500529
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: