Healthcare Provider Details

I. General information

NPI: 1811265440
Provider Name (Legal Business Name): MRS. REBEKAH HAYES AULD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 05/23/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 MDW 1100 WILFORD HALL LOOP
JBSA - LACKLAND AFB TX
78236
US

IV. Provider business mailing address

59 MDW 1100 WILFORD HALL LOOP
JBSA - LACKLAND AFB TX
78236
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-9900
  • Fax:
Mailing address:
  • Phone: 210-916-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9393
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: