Individual
REBECCA SUSAN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
269 GLENDALE CT, AVON, IN 46123-7143
(317) 417-0057
(317) 272-4049
Mailing address
269 GLENDALE CT, AVON, IN 46123-7143
(317) 417-0057
(317) 272-4049
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22004280A
IN
Other
Enumeration date
04/16/2007
Last updated
07/08/2007
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