Provider Demographics
NPI:1588890941
Name:PAULSEN, REBECCA SUE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SUE
Last Name:PAULSEN
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 1:2671 ORBIT DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1971
Mailing Address - Country:US
Mailing Address - Phone:248-895-4565
Mailing Address - Fax:
Practice Address - Street 1:1005 E 23RD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-0800
Practice Address - Country:US
Practice Address - Phone:866-784-2329
Practice Address - Fax:877-550-6600
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist