Provider Demographics
NPI:1487882262
Name:PALA, REBECCA MOYER (MA, CCC-SLP, ATP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:MOYER
Last Name:PALA
Suffix:
Gender:F
Credentials:MA, CCC-SLP, ATP
Other - Prefix:
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Other - Middle Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 NICOSH CIR UNIT 4105
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1240
Mailing Address - Country:US
Mailing Address - Phone:301-873-1365
Mailing Address - Fax:
Practice Address - Street 1:3009 NICOSH CIR UNIT 4105
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-1240
Practice Address - Country:US
Practice Address - Phone:301-873-1365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004946235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2202004946OtherSPEECH-LANGUAGE PATHOLOGY LICENSE FOR COMMONWEALTH OF VIRGINIA
DCSLP000235OtherDISTRICT OF COLUMBIA LICENSURE FOR SPEECH-LANGUAGE PATHOLOGY