Provider Demographics
NPI:1902911316
Name:SUPPES, REBECCA ANN (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANN
Last Name:SUPPES
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:HORNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3027 S NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-6131
Mailing Address - Country:US
Mailing Address - Phone:918-746-6800
Mailing Address - Fax:
Practice Address - Street 1:3027 S NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-6131
Practice Address - Country:US
Practice Address - Phone:918-746-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3078235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist