Provider Demographics
NPI:1942798624
Name:ABRAHAM, REBECCA ESTHER (MS SLP CFY)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ESTHER
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:MS SLP CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SOUTHAMPTON RD APT 195
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-1745
Mailing Address - Country:US
Mailing Address - Phone:602-579-5355
Mailing Address - Fax:
Practice Address - Street 1:2200 TUOLUMNE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2523
Practice Address - Country:US
Practice Address - Phone:707-644-7401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14505235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty