Provider Demographics
NPI:1336389246
Name:MADORE, REBECCA ANN (SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:MADORE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:SCHOB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1115 SE 164TH AVE DEPT 358
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3101 SE 192ND AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1442
Practice Address - Country:US
Practice Address - Phone:360-729-8010
Practice Address - Fax:360-729-8011
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR013266235Z00000X
WALL60134255235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist