Healthcare Provider Details

I. General information

NPI: 1710019971
Provider Name (Legal Business Name): REBECCA ANN GIAMBRA MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA ANN YOUNG MA, CCC-SLP

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9356 S SWEDE RD
BROCTON NY
14716-9612
US

IV. Provider business mailing address

9356 S SWEDE RD
BROCTON NY
14716-9612
US

V. Phone/Fax

Practice location:
  • Phone: 605-767-0586
  • Fax:
Mailing address:
  • Phone: 605-767-0586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number015555-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: