Provider Demographics
NPI:1053582700
Name:AKEN, REBECCA REXRODE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:REXRODE
Last Name:AKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LEE
Other - Last Name:REXRODE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:260 BONBROOK ROAD
Mailing Address - Street 2:
Mailing Address - City:WIRTZ
Mailing Address - State:VA
Mailing Address - Zip Code:24184
Mailing Address - Country:US
Mailing Address - Phone:434-319-0454
Mailing Address - Fax:276-293-1212
Practice Address - Street 1:128 FAYETTE STREET
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112
Practice Address - Country:US
Practice Address - Phone:276-352-4465
Practice Address - Fax:276-293-1212
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12049254235Z00000X
VA2202006873235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30017546930002Medicaid
WV3810007213Medicaid