Provider Demographics
NPI:1427314772
Name:GOMER, REBECCA (AUD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GOMER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:TIDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, F-AAA
Mailing Address - Street 1:4011 E RENNER RD STE 108
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2917
Mailing Address - Country:US
Mailing Address - Phone:972-803-8072
Mailing Address - Fax:214-238-3806
Practice Address - Street 1:915 W EXCHANGE PKWY # 180A
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-7017
Practice Address - Country:US
Practice Address - Phone:972-747-1333
Practice Address - Fax:972-747-1132
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51350231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist