Provider Demographics
NPI:1386124741
Name:PINA, REBECCA M (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:PINA
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 LUCE CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1277
Mailing Address - Country:US
Mailing Address - Phone:989-600-5372
Mailing Address - Fax:
Practice Address - Street 1:377 WESTRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-2137
Practice Address - Country:US
Practice Address - Phone:317-888-4948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist