Provider Demographics
NPI:1467941021
Name:ROMAN, RACHEL (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 S HIGLEY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-5045
Mailing Address - Country:US
Mailing Address - Phone:602-688-4838
Mailing Address - Fax:
Practice Address - Street 1:1525 S HIGLEY RD STE 104
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-5045
Practice Address - Country:US
Practice Address - Phone:602-688-4838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP11708235Z00000X
IL146013994235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist