Provider Demographics
NPI:1174181523
Name:LYMAN, RACHEL A
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:A
Last Name:LYMAN
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 1:61 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:AZ
Mailing Address - Zip Code:85611-7802
Mailing Address - Country:US
Mailing Address - Phone:520-455-4602
Mailing Address - Fax:
Practice Address - Street 1:61 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:AZ
Practice Address - Zip Code:85611-7802
Practice Address - Country:US
Practice Address - Phone:520-455-4602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1259235Z00000X
01110673235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01110673OtherASHA AMERICAN SPEECH AND HEARING ASSOCIATION
AZ1259OtherAZ DEPARTMENT OF HEALTH SERVICES OFFIE OF SPECIAL LICENSING