Healthcare Provider Details

I. General information

NPI: 1114837077
Provider Name (Legal Business Name): REBECCA SARGENT SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA BLAYLOCK

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 N CUSTER AVE
GRAND ISLAND NE
68803-4304
US

IV. Provider business mailing address

PO BOX 5285
GRAND ISLAND NE
68802-5285
US

V. Phone/Fax

Practice location:
  • Phone: 308-398-1202
  • Fax: 308-398-5232
Mailing address:
  • Phone: 308-675-1853
  • Fax: 308-210-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number081
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: