Provider Demographics
NPI:1376263467
Name:GIAMBANCO, RACHEL MICHELLE (MACCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:MICHELLE
Last Name:GIAMBANCO
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 UPTON WAY
Mailing Address - Street 2:
Mailing Address - City:DANIELS
Mailing Address - State:WV
Mailing Address - Zip Code:25832-9065
Mailing Address - Country:US
Mailing Address - Phone:304-573-9079
Mailing Address - Fax:
Practice Address - Street 1:105 ADAIR ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3733
Practice Address - Country:US
Practice Address - Phone:304-256-4577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV235Z00000X235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist