Provider Demographics
NPI:1558346486
Name:RUSH, RACHEAL FAYE (MCD CCCA)
Entity Type:Individual
Prefix:
First Name:RACHEAL
Middle Name:FAYE
Last Name:RUSH
Suffix:
Gender:F
Credentials:MCD CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 BORTHWICK AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7111
Mailing Address - Country:US
Mailing Address - Phone:603-436-8668
Mailing Address - Fax:603-436-4499
Practice Address - Street 1:330 BORTHWICK AVE STE 209
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7111
Practice Address - Country:US
Practice Address - Phone:603-436-8668
Practice Address - Fax:860-436-4499
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA741231H00000X
NHA838231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAD0175OtherBLUE CROSS BLUE SHIELD
MAAD0175OtherBLUE CROSS BLUE SHIELD