Individual
REBECCA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4330 HIGHWAY 78 E, SUITE 118, JASPER, AL 35501-8905
(866) 537-5613
Mailing address
484 VALLEY SCHOOL RD, JASPER, AL 35504-6437
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
935
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
935
SPEECH THERAPY LICENSE
AL
Enumeration date
12/29/2006
Last updated
07/08/2007
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