Provider Demographics
NPI:1912084302
Name:POWELL, REBECCA LYNN (AUD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:POWELL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:FIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:750 N COMMONS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7940
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:630-303-5385
Practice Address - Street 1:1820 COIT RD
Practice Address - Street 2:SUITE 120
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-5036
Practice Address - Country:US
Practice Address - Phone:972-519-8490
Practice Address - Fax:972-758-5326
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80412237600000X, 231H00000X, 237600000X
231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB144446Medicare PIN