Provider Demographics
NPI:1154912244
Name:SIMONEAUX, REBECCA CLAIRE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:CLAIRE
Last Name:SIMONEAUX
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:CLAIRE
Other - Last Name:REEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2606 E 2ND ST APT D
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5353
Mailing Address - Country:US
Mailing Address - Phone:765-438-9945
Mailing Address - Fax:
Practice Address - Street 1:965 EMERSON PKWY
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-6273
Practice Address - Country:US
Practice Address - Phone:317-324-3765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22007211A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist