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General NPI Number Information
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NPI Number | 1043940943
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Entity Type | Individual
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Provider Name | MRS. REBECCA ANN ST.AMANT
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Gender | Female
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Dates
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Enumeration Date | 06/14/2022
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 3524 N CRUMP ST
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City | FORT WORTH
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State | TX
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Zip | 76106-4420
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Country | US
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Telephone | 817-815-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 5221 AGAVE WAY
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City | FORT WORTH
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State | TX
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Zip | 76126-3040
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Country | US
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Telephone | 817-905-9397
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 109235
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License Number State | TX
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