Provider Demographics
NPI:1477681203
Name:ROSE, RACHEL CORNETT (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:CORNETT
Last Name:ROSE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 HIGHWAY 522
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:KY
Mailing Address - Zip Code:40806-8562
Mailing Address - Country:US
Mailing Address - Phone:606-574-0123
Mailing Address - Fax:606-574-0198
Practice Address - Street 1:162 HIGHWAY 522
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:KY
Practice Address - Zip Code:40806-8562
Practice Address - Country:US
Practice Address - Phone:606-574-0123
Practice Address - Fax:606-574-0198
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2456235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1377OtherFIRST STEPS PROVIDER #