Provider Demographics
NPI:1124308366
Name:RATLIFF, REBECCA ANN (AUD)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ANN
Last Name:RATLIFF
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:P.O. BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6718
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:5153 NORTH 9TH AVE.
Practice Address - Street 2:NEMOURS CHILDRENS CLINIC, PENSACOLA
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8785
Practice Address - Country:US
Practice Address - Phone:850-505-4735
Practice Address - Fax:850-505-4711
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003861231H00000X
FLAY1744231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS00WUOtherBCBS OF FLORIDA