Healthcare Provider Details

I. General information

NPI: 1619702438
Provider Name (Legal Business Name): REBECCA REPPERT ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 3RD ST
RADFORD VA
24141-4502
US

IV. Provider business mailing address

712 3RD ST
RADFORD VA
24141-4502
US

V. Phone/Fax

Practice location:
  • Phone: 301-885-6921
  • Fax:
Mailing address:
  • Phone: 301-885-6921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPPS-0605211
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: