Provider Demographics
NPI:1003023953
Name:FERGUSON, RACHELLE LYN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:LYN
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8607 ROBIN RUN WAY
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-1218
Mailing Address - Country:US
Mailing Address - Phone:317-203-6278
Mailing Address - Fax:
Practice Address - Street 1:8616 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234-2167
Practice Address - Country:US
Practice Address - Phone:317-209-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46001588A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist