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General NPI Number Information
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NPI Number | 1427307453
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Entity Type | Individual
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Provider Name | REBECCA SIDDERS PICKERING MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/06/2012
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 508 WILLIAMSON ROAD SUITE 100 B, MOORESVILLE, NC, 28117 SUITE 100 B
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City | MOORESVILLE
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State | NC
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Zip | 28117-2811
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Country | US
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Telephone | 980-447-2701
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Fax |
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Provider Business Mailing Address
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Address Line | 323 PRESTON RD
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City | MOORESVILLE
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State | NC
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Zip | 28117-8612
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Country | US
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Telephone | 318-366-6205
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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 | 14085
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License Number State | NC
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