Provider Demographics
NPI:1891078093
Name:DIEM, RACHEL BETH (MA CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:BETH
Last Name:DIEM
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:BETH
Other - Last Name:PANAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC/SLP
Mailing Address - Street 1:1126 WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042
Mailing Address - Country:US
Mailing Address - Phone:717-274-3493
Mailing Address - Fax:717-274-1304
Practice Address - Street 1:1126 WALNUT STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042
Practice Address - Country:US
Practice Address - Phone:717-274-3493
Practice Address - Fax:717-274-1304
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010172235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist