Provider Demographics
NPI:1174566830
Name:RICH, REBECCA (MS CF/A, MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:RICH
Suffix:
Gender:F
Credentials:MS CF/A, MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 6TH AVE SE
Mailing Address - Street 2:STE 8C
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2201 6TH AVE SE
Practice Address - Street 2:STE 8C
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401
Practice Address - Country:US
Practice Address - Phone:605-725-4327
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDT-316A231H00000X
SD12014404235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5835140Medicaid