Provider Demographics
NPI:1104513001
Name:STEPHAN, REBECCA GAY (SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:GAY
Last Name:STEPHAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 OUTTA PL
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-2032
Mailing Address - Country:US
Mailing Address - Phone:907-244-8829
Mailing Address - Fax:
Practice Address - Street 1:1441 W NORTHERN LIGHTS BLVD STE G
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2324
Practice Address - Country:US
Practice Address - Phone:907-244-8829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK156225235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist