Basic Information
| Provider Information | |||||||||
| NPI: | 1417550039 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HABER | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S.ED, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19851 BRECKENRIDGE DR UNIT 202 | ||||||||
| Address2: | |||||||||
| City: | ESTERO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339284147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317456715 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4997 ROYAL GULF CIR | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339667006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393135049 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2020 | ||||||||
| LastUpdateDate: | 01/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | N | Other Service Providers | Specialist | 235Z00000X | SZ10006 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.