Provider Demographics
NPI:1366432528
Name:EBERLE, REBECCA D (MA, CCC-SLP, BC-NC)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:D
Last Name:EBERLE
Suffix:
Gender:F
Credentials:MA, CCC-SLP, BC-NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3918 STONEGATE CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-9801
Mailing Address - Country:US
Mailing Address - Phone:812-333-4368
Mailing Address - Fax:
Practice Address - Street 1:200 S JORDAN AVE
Practice Address - Street 2:DEPARTMENT OF SPEECH AND HEARING SCIENCES
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47405
Practice Address - Country:US
Practice Address - Phone:812-855-1069
Practice Address - Fax:812-855-5561
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22001596A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11512049OtherCAQH PROVIDER ID
IN11512049OtherCAQH PROVIDER ID