Provider Demographics
NPI:1598095754
Name:ANDERSON, RACHEL W (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:W
Last Name:ANDERSON
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 1:4500 I-55 NORTH
Mailing Address - Street 2:SUITE 291, HIGHLAND VILLAGE
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211
Mailing Address - Country:US
Mailing Address - Phone:601-362-0859
Mailing Address - Fax:601-362-0870
Practice Address - Street 1:4500 I-55 N
Practice Address - Street 2:SUITE 291, HIGHLAND VILLAGE
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5930
Practice Address - Country:US
Practice Address - Phone:601-362-0859
Practice Address - Fax:601-362-0870
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3417235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSS3417OtherMISSISSIPPI STATE DEPARTMENT OF HEALTH LICENSE