Provider Demographics
NPI:1285080432
Name:LOWRY, REBECCA STEVENSON (PHD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:STEVENSON
Last Name:LOWRY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:S
Other - Last Name:LOWRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4051 DANERN DR
Mailing Address - Street 2:BEAVERCREEK
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45430-2039
Mailing Address - Country:US
Mailing Address - Phone:937-307-4869
Mailing Address - Fax:
Practice Address - Street 1:336 ELM ST
Practice Address - Street 2:LONDON HIGH SCHOOL
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-9220
Practice Address - Country:US
Practice Address - Phone:740-852-5705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21119961103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool