Provider Demographics
NPI:1609447200
Name:SHADELL, RACHAEL (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:SHADELL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:112 SAGEBRUSH LN
Mailing Address - Street 2:
Mailing Address - City:ROMANCE
Mailing Address - State:AR
Mailing Address - Zip Code:72136-6922
Mailing Address - Country:US
Mailing Address - Phone:479-502-1136
Mailing Address - Fax:
Practice Address - Street 1:2800 S 2ND ST STE B
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-7030
Practice Address - Country:US
Practice Address - Phone:501-286-6075
Practice Address - Fax:501-286-6175
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR14355991235Z00000X
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist