Provider Demographics
NPI:1760797831
Name:GLADE, RACHEL ELIZABETH (SLP, LSLS CERT AVT)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:GLADE
Suffix:
Gender:F
Credentials:SLP, LSLS CERT AVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 N. RAZORBACK ROAD
Mailing Address - Street 2:UA SPEECH & HEARING CLINIC
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701
Mailing Address - Country:US
Mailing Address - Phone:479-575-3575
Mailing Address - Fax:479-575-4507
Practice Address - Street 1:606 N. RAZORBACK ROAD
Practice Address - Street 2:UA SPEECH & HEARING CLINIC
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701
Practice Address - Country:US
Practice Address - Phone:479-575-3575
Practice Address - Fax:479-575-4507
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P8329235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist