Provider Demographics
NPI:1043468044
Name:GREEN, RACHEL L
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:L
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 STONEWAY LN
Mailing Address - Street 2:APT B
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-4340
Mailing Address - Country:US
Mailing Address - Phone:772-461-8562
Mailing Address - Fax:
Practice Address - Street 1:787 37TH ST
Practice Address - Street 2:SUITE E-100
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7305
Practice Address - Country:US
Practice Address - Phone:772-567-0061
Practice Address - Fax:772-567-0062
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI15702355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant