Provider Demographics
NPI:1902388655
Name:KING, RACHEL TAYLOR (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:TAYLOR
Last Name:KING
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7545 E NORTHWEST HWY APT 448
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-4249
Mailing Address - Country:US
Mailing Address - Phone:903-283-3978
Mailing Address - Fax:
Practice Address - Street 1:5585 CARUTH HAVEN LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-8157
Practice Address - Country:US
Practice Address - Phone:903-283-3978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113027235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113027OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION