MEDICARE: MRS. REBECCA LYNN NEELY M.S. CCC/SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	1168852	PA
2	235Z00000X	Speech-Language Pathologist	2020023156	MO
3	235Z00000X	Speech-Language Pathologist	111664	TX

General Provider Information

NPI Number	:	1104477223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA LYNN NEELY M.S. CCC/SLP

Provider Business Mailing Address
First Line	:	1919 MARKET ST UNIT 2705
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-1947
Country	:	US
Telephone Number	:	409-719-2970
Fax Number	:	817-789-6849

Provider Business Practice Location Address
First Line	:	1919 MARKET ST UNIT 2705
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-1947
Country	:	US
Telephone Number	:	409-719-2970
Fax Number	:	817-789-6849

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2019
Last Update Date	:	08/12/2020

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Directions to “ MRS. REBECCA LYNN NEELY M.S. CCC/SLP” Practice Location

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