Provider Demographics
NPI:1548152267
Name:TEDLOCK, REBEKAH R
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:R
Last Name:TEDLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14735 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:HENRYETTA
Mailing Address - State:OK
Mailing Address - Zip Code:74437-7534
Mailing Address - Country:US
Mailing Address - Phone:405-434-9213
Mailing Address - Fax:
Practice Address - Street 1:14735 CEDAR RD
Practice Address - Street 2:
Practice Address - City:HENRYETTA
Practice Address - State:OK
Practice Address - Zip Code:74437-7534
Practice Address - Country:US
Practice Address - Phone:405-434-9213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst