Provider Demographics
NPI:1235747312
Name:KACZMARCZYK, RACHEL RENEE
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:RENEE
Last Name:KACZMARCZYK
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 1:14713 WINTERFIELD CT
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-2939
Mailing Address - Country:US
Mailing Address - Phone:703-424-0165
Mailing Address - Fax:
Practice Address - Street 1:21351 GENTRY DR STE 265
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-8514
Practice Address - Country:US
Practice Address - Phone:571-449-6281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist