Provider Demographics
NPI:1326279571
Name:BENNETT, RACHEL DIANE (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:DIANE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:DIANE
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC/SLP
Mailing Address - Street 1:PO BOX 2791
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-7791
Mailing Address - Country:US
Mailing Address - Phone:469-337-4875
Mailing Address - Fax:
Practice Address - Street 1:627 S PALESTINE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3355
Practice Address - Country:US
Practice Address - Phone:903-675-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104254235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist