Provider Demographics
NPI:1124251855
Name:RECTOR, SERENA RENE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:RENE
Last Name:RECTOR
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 BRADDOCK DR
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-6311
Mailing Address - Country:US
Mailing Address - Phone:910-703-9169
Mailing Address - Fax:
Practice Address - Street 1:317 BRADDOCK DR
Practice Address - Street 2:DUMC BOX 3887
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-6311
Practice Address - Country:US
Practice Address - Phone:910-703-9169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8636235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12156608OtherAMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION CERTIFICATION-CCC