MEDICARE: REBECCA BRISTOW 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	110842	TX

General Provider Information

NPI Number	:	1376076455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA BRISTOW M.S.,CCC-SLP

Provider Business Mailing Address
First Line	:	555 E 5TH ST
Second Line	:	APT 2822
City	:	AUSTIN
State	:	TX
Zip	:	78701-4157
Country	:	US
Telephone Number	:	512-925-3381
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 E 5TH ST
Second Line	:	APT 2822
City	:	AUSTIN
State	:	TX
Zip	:	78701-4157
Country	:	US
Telephone Number	:	512-925-3381
Fax Number	:

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

Provider Enumeration Date	:	04/06/2017
Last Update Date	:	04/06/2017

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Directions to “ REBECCA BRISTOW M.S.,CCC-SLP” Practice Location

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