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NPI Code Detail

MEDICARE: REBECCA J GREEN SLP, MA

MEDICARE:   REBECCA J GREEN  SLP, MA
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
1235Z00000XSpeech-Language Pathologist22855CA

General Provider Information

NPI Number : 1760974166
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA J GREEN SLP, MA
Provider Business Mailing Address
First Line : 1790 NANTUCKET CIR APT 370
Second Line :
City : SANTA CLARA
State : CA
Zip : 95054-3828
Country : US
Telephone Number : 415-770-7599
Fax Number :
Provider Business Practice Location Address
First Line : 1790 NANTUCKET CIR APT 370
Second Line :
City : SANTA CLARA
State : CA
Zip : 95054-3828
Country : US
Telephone Number : 415-770-7599
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2018
Last Update Date : 05/31/2018

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Directions to “ REBECCA J GREEN SLP, MA” Practice Location

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