Provider Demographics
NPI:1508911082
Name:ISENBERG, RACHEL DIANE (MACCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:DIANE
Last Name:ISENBERG
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 1:589 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-2515
Mailing Address - Country:US
Mailing Address - Phone:423-215-3029
Mailing Address - Fax:423-286-3787
Practice Address - Street 1:589 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-2515
Practice Address - Country:US
Practice Address - Phone:423-215-3029
Practice Address - Fax:423-286-3787
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1655235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN730447OtherOPTUMHEALTH
TN1502185Medicaid
TN4265417OtherBLUE CROSS BLUE SHIELD
TN1508911082Medicare UPIN