Provider Demographics
NPI:1366943649
Name:HAAS, REBECCA ANN (MCD, CCC- SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:HAAS
Suffix:
Gender:F
Credentials:MCD, CCC- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 TRAW LANE
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH SPRING
Mailing Address - State:AR
Mailing Address - Zip Code:72554
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:314 LONGHORN DR
Practice Address - Street 2:
Practice Address - City:VIOLA
Practice Address - State:AR
Practice Address - Zip Code:72583-9129
Practice Address - Country:US
Practice Address - Phone:870-458-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP9217235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist