1851028906 NPI number — REBEKAH JO LANGLEY MCD-CCC/SLP

Table of content: REBEKAH JO LANGLEY MCD-CCC/SLP (NPI 1851028906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851028906 NPI number — REBEKAH JO LANGLEY MCD-CCC/SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANGLEY
Provider First Name:
REBEKAH
Provider Middle Name:
JO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MCD-CCC/SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851028906
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16352 LAKEVIEW CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROUP
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75789-3610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-235-9967
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARP
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75750-4607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-859-4650
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  24521 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com