=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306119607
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA LEE DANA M.S. CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2012
-----------------------------------------------------
Last Update Date | 02/18/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7002 LEBANON RD. SUITE 130
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75034-7461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-408-4634
-----------------------------------------------------
Fax | 972-618-1051
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7628 TWELVE OAKS CIR
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-673-9861
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 103026
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------