Provider Demographics
NPI:1285893354
Name:RUSSELL, REBECCA AMBER CROWE (MS , CCC-SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:AMBER CROWE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MS , CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13721 HERITAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352
Mailing Address - Country:US
Mailing Address - Phone:910-206-8228
Mailing Address - Fax:
Practice Address - Street 1:13721 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-9185
Practice Address - Country:US
Practice Address - Phone:910-206-8228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7173235Z00000X
SC4110235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist