Provider Demographics
NPI:1710318423
Name:HARRISON, REBECCA WILSON (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:WILSON
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:RAE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:2024 COTTAGE WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27803-1653
Mailing Address - Country:US
Mailing Address - Phone:252-801-6379
Mailing Address - Fax:
Practice Address - Street 1:911 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-4016
Practice Address - Country:US
Practice Address - Phone:252-823-2041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12139228235Z00000X
NC8424235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist