Provider Demographics
NPI:1902680119
Name:OLIVER, REBEKAH GRACE
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:GRACE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HICKORY POINTE CV
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-5085
Mailing Address - Country:US
Mailing Address - Phone:501-786-7722
Mailing Address - Fax:
Practice Address - Street 1:1200 RESERVOIR RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-5712
Practice Address - Country:US
Practice Address - Phone:501-447-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist