Provider Demographics
NPI:1609904481
Name:DUVALL-SHAW, RACHEL BLEDSOE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:BLEDSOE
Last Name:DUVALL-SHAW
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 1:314 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-2716
Mailing Address - Country:US
Mailing Address - Phone:502-226-4304
Mailing Address - Fax:
Practice Address - Street 1:314 W 3RD ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-2716
Practice Address - Country:US
Practice Address - Phone:502-226-4304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2591235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist