Provider Demographics
NPI:1558615690
Name:GARNER, RACHEL M (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:M
Last Name:GARNER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-2950
Mailing Address - Country:US
Mailing Address - Phone:662-321-0805
Mailing Address - Fax:
Practice Address - Street 1:119 WILLOW RD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-2950
Practice Address - Country:US
Practice Address - Phone:662-321-0805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3701235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist