Provider Demographics
NPI:1588736409
Name:DAUGHERTY, REBEKAH FITE (SLP)
Entity type:Individual
Prefix:MS
First Name:REBEKAH
Middle Name:FITE
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:KATHERINE
Other - Last Name:FITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1537 ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-8536
Mailing Address - Country:US
Mailing Address - Phone:724-858-9433
Mailing Address - Fax:
Practice Address - Street 1:500 BROUWERS DR
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-2500
Practice Address - Country:US
Practice Address - Phone:724-537-6412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008525235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist