Healthcare Provider Details

I. General information

NPI: 1104882448
Provider Name (Legal Business Name): REBECCA ANN WALKER M.A., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA ANN BENEDICT M.A., CCC-A

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3893 E MARKET ST
WARREN OH
44484-4706
US

IV. Provider business mailing address

3893 E MARKET ST
WARREN OH
44484-4706
US

V. Phone/Fax

Practice location:
  • Phone: 330-856-4000
  • Fax: 330-609-9910
Mailing address:
  • Phone: 330-856-4000
  • Fax: 330-609-9910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA.01595
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: