Provider Demographics
NPI:1235274671
Name:REED, RACHEL G (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:G
Last Name:REED
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5553
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32540-5553
Mailing Address - Country:US
Mailing Address - Phone:850-337-1378
Mailing Address - Fax:888-852-6279
Practice Address - Street 1:1653 WOODLAWN BEACH RD
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-9538
Practice Address - Country:US
Practice Address - Phone:850-712-3786
Practice Address - Fax:888-852-6279
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FL0000887235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019173100Medicaid
FL017324000Medicaid