MEDICARE: REBECCA LARUSSA 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	11267	AZ

General Provider Information

NPI Number	:	1700370772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA LARUSSA M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	121 SWINICK DR
Second Line	:
City	:	DUNMORE
State	:	PA
Zip	:	18512-2078
Country	:	US
Telephone Number	:	570-687-5485
Fax Number	:

Provider Business Practice Location Address
First Line	:	532 GIBSON DR STE 100
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-5878
Country	:	US
Telephone Number	:	866-564-3589
Fax Number	:

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

Provider Enumeration Date	:	06/21/2018
Last Update Date	:	06/21/2018

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

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