Provider Demographics
NPI:1063043602
Name:REBECCA MONKS SPEECH THERAPY, P.C.
Entity type:Organization
Organization Name:REBECCA MONKS SPEECH THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:PRICE
Authorized Official - Last Name:MONKS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:207-504-1457
Mailing Address - Street 1:21 PATRICIA DR
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1319
Mailing Address - Country:US
Mailing Address - Phone:207-504-1457
Mailing Address - Fax:
Practice Address - Street 1:21 PATRICIA DR
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1319
Practice Address - Country:US
Practice Address - Phone:207-504-1457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-02
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMETPID006877Medicaid