Provider Demographics
NPI:1174241962
Name:HAVERLIN, REBECCA ANN (MAT, MS)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ANN
Last Name:HAVERLIN
Suffix:
Gender:F
Credentials:MAT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 NJ-73
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:856-375-2914
Mailing Address - Fax:
Practice Address - Street 1:751 NJ-73
Practice Address - Street 2:SUITE 1
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:732-856-2095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7999235Z00000X
NJ41YS01163200235Z00000X
FLSA23019235Z00000X
MASLP101292235Z00000X
VA2202011729235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist