MEDICARE: MRS. REBECCA MARIE KONTONICKAS MA-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

General Provider Information

NPI Number	:	1982121745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA MARIE KONTONICKAS MA-CCC-SLP

Provider Business Mailing Address
First Line	:	3657 LAKEWOOD DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248-3119
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2840 BOUDINOT AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-2425
Country	:	US
Telephone Number	:	513-363-0978
Fax Number	:

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

Provider Enumeration Date	:	08/23/2017
Last Update Date	:	08/23/2017

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Directions to “ MRS. REBECCA MARIE KONTONICKAS MA-CCC-SLP” Practice Location

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