Provider Demographics
NPI:1548246721
Name:CUMBO, REBECCA SOLOMON (MED/CCC)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SOLOMON
Last Name:CUMBO
Suffix:
Gender:F
Credentials:MED/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3640 WESTGATE CENTER CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3056
Mailing Address - Country:US
Mailing Address - Phone:336-659-0806
Mailing Address - Fax:336-659-1054
Practice Address - Street 1:3640 WESTGATE CENTER CIR
Practice Address - Street 2:SUITE A
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3056
Practice Address - Country:US
Practice Address - Phone:336-659-0806
Practice Address - Fax:336-659-1054
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC829235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCB1272OtherMEDCOST PRACTICE ID
NC26450OtherBCBS PROVIDER NUMBER
NC7426450Medicaid
NC51047116OtherTRICARE PROVIDER NUMBER
NCE2524OtherMEDCOST DR ID