Provider Demographics
NPI:1104477223
Name:NEELY, REBECCA LYNN (MS CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNN
Last Name:NEELY
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:MOSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSCCC/SLP
Mailing Address - Street 1:1919 MARKET ST UNIT 2705
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1947
Mailing Address - Country:US
Mailing Address - Phone:409-719-2970
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:1919 MARKET ST UNIT 2705
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1947
Practice Address - Country:US
Practice Address - Phone:409-719-2970
Practice Address - Fax:817-789-6849
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1168852235Z00000X
MO2020023156235Z00000X
TX111664235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty