Provider Demographics
NPI:1407189715
Name:MANN, RACHEL L (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:L
Last Name:MANN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:L
Other - Last Name:ROSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACCC-SLP
Mailing Address - Street 1:280 HIGH AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2407
Mailing Address - Country:US
Mailing Address - Phone:845-548-3315
Mailing Address - Fax:845-512-8034
Practice Address - Street 1:280 HIGH AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2407
Practice Address - Country:US
Practice Address - Phone:845-548-3315
Practice Address - Fax:845-512-8034
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019475-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist