Provider Demographics
NPI:1861805400
Name:PHEGLEY, RABECCA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:RABECCA
Middle Name:
Last Name:PHEGLEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 S JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-5247
Mailing Address - Country:US
Mailing Address - Phone:815-441-8558
Mailing Address - Fax:
Practice Address - Street 1:129 S JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-5247
Practice Address - Country:US
Practice Address - Phone:815-441-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46002595A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist