Basic Information
| Provider Information | |||||||||
| NPI: | 1053746073 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | REBECCA | ||||||||
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| Credential: | SLP,CCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15150 BLANCO RD | ||||||||
| Address2: | 16-102 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782323308 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2203 BABCOCK RD | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782294412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106143911 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2013 | ||||||||
| LastUpdateDate: | 07/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 110076 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 390200000X | 109197 | TX | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.