Provider Demographics
NPI:1063794204
Name:BUELL, REBECCA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BUELL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:BUELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:NORTH GREECE
Mailing Address - State:NY
Mailing Address - Zip Code:14515-0300
Mailing Address - Country:US
Mailing Address - Phone:585-966-4859
Mailing Address - Fax:
Practice Address - Street 1:1144 LONG POND RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-1181
Practice Address - Country:US
Practice Address - Phone:585-966-4859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006501235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist