Healthcare Provider Details

I. General information

NPI: 1912152000
Provider Name (Legal Business Name): REBECCA BETH KOBLICK MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 ROUTE 59 SUITE 102
AIRMONT NY
10952-3428
US

IV. Provider business mailing address

251 GRANDVIEW AVE
SUFFERN NY
10901-2806
US

V. Phone/Fax

Practice location:
  • Phone: 845-368-7927
  • Fax:
Mailing address:
  • Phone: 845-364-5264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number017623-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: