Provider Demographics
NPI:1497223697
Name:WEST, RACHEL MARIE (M A CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:WEST
Suffix:
Gender:F
Credentials:M A CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 S 4TH ST UNIT 303
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2556
Mailing Address - Country:US
Mailing Address - Phone:317-750-2157
Mailing Address - Fax:
Practice Address - Street 1:12011 SHELBYVILLE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-4024
Practice Address - Country:US
Practice Address - Phone:317-750-2157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY241317235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist