Provider Demographics
NPI:1427307453
Name:PICKERING, REBECCA SIDDERS (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SIDDERS
Last Name:PICKERING
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 1:323 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8612
Mailing Address - Country:US
Mailing Address - Phone:318-366-6205
Mailing Address - Fax:
Practice Address - Street 1:508 WILLIAMSON ROAD SUITE 100 B, MOORESVILLE, NC, 28117
Practice Address - Street 2:SUITE 100 B
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-2811
Practice Address - Country:US
Practice Address - Phone:980-447-2701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14085235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist