Provider Demographics
NPI:1679248595
Name:SQUYRES, RACHEL MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:SQUYRES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HOLCOMB ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4404
Mailing Address - Country:US
Mailing Address - Phone:479-717-6464
Mailing Address - Fax:
Practice Address - Street 1:301 HOLCOMB ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4404
Practice Address - Country:US
Practice Address - Phone:479-717-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR201532235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist