Basic Information
| Provider Information | |||||||||
| NPI: | 1508335845 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOUGEL | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3299 HUNTSMAN DR | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206392327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309312007 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 800 CYPRESS WATERS BLVD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007884815 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2018 | ||||||||
| LastUpdateDate: | 11/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 01761L | MD | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.