Provider Demographics
NPI:1033616958
Name:FASULO, REBECCA CATHERINE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:CATHERINE
Last Name:FASULO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 GROVE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2439
Mailing Address - Country:US
Mailing Address - Phone:203-215-8283
Mailing Address - Fax:
Practice Address - Street 1:35 WHEELBARROW LN
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-2003
Practice Address - Country:US
Practice Address - Phone:203-468-3261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-07
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005861235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist