Provider Demographics
NPI:1710454236
Name:FANN, RACHEL BRIANA (CCC-SLP, CLC)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:BRIANA
Last Name:FANN
Suffix:
Gender:F
Credentials:CCC-SLP, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 TWO HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2675
Mailing Address - Country:US
Mailing Address - Phone:919-246-0418
Mailing Address - Fax:
Practice Address - Street 1:110 TWO HILLS DR
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-2675
Practice Address - Country:US
Practice Address - Phone:919-246-0418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
NC1908051235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN