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1750441697 NPI number — REBECCA JO ANDERSON MS CCC SLP

NPI Number: 1750441697
Health Care Provider/Practitioner: REBECCA JO ANDERSON MS CCC SLP

Information about “1750441697” NPI (REBECCA JO ANDERSON MS CCC SLP) exists in 1750441697 in HTML format HTML  |  1750441697 in plain Text format TXT  |  1750441697 in PDF (Portable Document Format) PDF  |  1750441697 in an XML format XML  formats.

NPI Number : 1750441697 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1750441697",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ANDERSON",
    "FirstName": "REBECCA",
    "MiddleName": "JO",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MS CCC SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MCINTYRE",
    "OtherFirstName": "REBECA",
    "OtherMiddleName": "JO",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MS CCC SLP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "220 A OLD TURNPIKE RD EAST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BRIDGEWATER",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06752",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "203-240-4250",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4BERSHIRE BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BETHEL",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06801-1001",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "203-826-3136",
    "PracticeLocationAddressFaxNumber": "203-775-6810",
    "EnumerationDate": "12/11/2006",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "235Z00000X",
        "TaxonomyName": "Speech-Language Pathologist",
        "LicenseNumber": "001746",
        "LicenseNumberStateCode": "CT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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