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General NPI Number Information
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NPI Number | 1700367430
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Entity Type | Individual
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Provider Name | REBECCA NIELSEN MS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 08/21/2018
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Provider Practice Location Address
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Address Line | 2115 1ST AVE SE
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City | CEDAR RAPIDS
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State | IA
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Zip | 52402-6353
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Country | US
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Telephone | 319-363-2420
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Fax |
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Provider Business Mailing Address
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Address Line | 280 PHEASANT AVE
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City | MARION
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State | IA
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Zip | 52302-5667
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Country | US
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Telephone |
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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 | 085650
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License Number State | IA
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