Provider Demographics
NPI:1447978101
Name:BURKE, REBECCA (SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S TWIN OAKS VALLEY RD STE 107
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4387
Mailing Address - Country:US
Mailing Address - Phone:661-205-1796
Mailing Address - Fax:
Practice Address - Street 1:1240 CALLE FANTASIA
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-7329
Practice Address - Country:US
Practice Address - Phone:661-205-1796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26968235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist