Provider Demographics
NPI:1164288106
Name:HOLT, RACHELLE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:HOLT
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 1:65-2 DREXELBROOK DR APT 2
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-5534
Mailing Address - Country:US
Mailing Address - Phone:215-704-0426
Mailing Address - Fax:
Practice Address - Street 1:1700 MARKET ST STE 1005
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-3920
Practice Address - Country:US
Practice Address - Phone:215-839-6144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL015264235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist