Provider Demographics
NPI:1285010686
Name:SEUBERT, RACHEL (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:SEUBERT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:KADISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14130 PERSHING CRES APT 6D
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1919
Mailing Address - Country:US
Mailing Address - Phone:347-523-0886
Mailing Address - Fax:
Practice Address - Street 1:14130 PERSHING CRES APT 6D
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-1919
Practice Address - Country:US
Practice Address - Phone:347-523-0886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-07
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04513851Medicaid