Basic Information
Provider Information | |||||||||
NPI: | 1386891422 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCHNELL | ||||||||
FirstName: | REBECCA | ||||||||
MiddleName: | DIANE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.A., CCC-SLP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | GARCIA | ||||||||
OtherFirstName: | REBECCA | ||||||||
OtherMiddleName: | DIANE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.A., CCC-SLP | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1027 NE KAYAK LOOP UNIT 1 | ||||||||
Address2: |   | ||||||||
City: | BEND | ||||||||
State: | OR | ||||||||
PostalCode: | 977016890 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5126991054 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 25117 SW PARKWAY AVE | ||||||||
Address2: | SUITE D | ||||||||
City: | WILSONVILLE | ||||||||
State: | OR | ||||||||
PostalCode: | 970709697 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5035703665 | ||||||||
FaxNumber: | 5035709155 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/20/2008 | ||||||||
LastUpdateDate: | 08/21/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 12985 | OR | Y |   | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |   |
No ID Information.