Provider Demographics
NPI:1104057199
Name:KELLOGG, REBECCA LEEANNE (AUD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LEEANNE
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 BOYSON RD
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2313
Mailing Address - Country:US
Mailing Address - Phone:319-393-2796
Mailing Address - Fax:
Practice Address - Street 1:245 W STATE HIGHWAY 114
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-3637
Practice Address - Country:US
Practice Address - Phone:319-393-2796
Practice Address - Fax:319-393-4782
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA093218237600000X
TX80138237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter