Provider Demographics
NPI:1053804807
Name:MOILANEN, REBEKAH (MT-BC)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:MOILANEN
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:
Other - Last Name:STOUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5879 BIBON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-8317
Mailing Address - Country:US
Mailing Address - Phone:517-914-3430
Mailing Address - Fax:
Practice Address - Street 1:1001 LAURENCE AVE STE D
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2978
Practice Address - Country:US
Practice Address - Phone:517-416-1088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI08487225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist