Provider Demographics
NPI:1073004677
Name:DUKE, RACHEL B (MED CCCSLP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:B
Last Name:DUKE
Suffix:
Gender:F
Credentials:MED CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107B DEER TRL NE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-8716
Mailing Address - Country:US
Mailing Address - Phone:478-414-8876
Mailing Address - Fax:
Practice Address - Street 1:545 OLD NORCROSS RD STE 200
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046
Practice Address - Country:US
Practice Address - Phone:678-377-2833
Practice Address - Fax:678-502-7800
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-20
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP010191235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty