Provider Demographics
NPI:1750652913
Name:DAVIS, RACHEL (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, 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:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:GRUNDY
Mailing Address - State:VA
Mailing Address - Zip Code:24614-0298
Mailing Address - Country:US
Mailing Address - Phone:276-935-7207
Mailing Address - Fax:
Practice Address - Street 1:945 W RUSSELL ST
Practice Address - Street 2:
Practice Address - City:ELKHORN CITY
Practice Address - State:KY
Practice Address - Zip Code:41522-9032
Practice Address - Country:US
Practice Address - Phone:606-754-4134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-3604235Z00000X
VA2202005875235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist