Provider Demographics
NPI:1962000893
Name:VAN VLIET, RACHEL N (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:N
Last Name:VAN VLIET
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 1:1401 BRIGHTON ST
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-3201
Mailing Address - Country:US
Mailing Address - Phone:562-448-8217
Mailing Address - Fax:
Practice Address - Street 1:3002 DOW AVE STE 114
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7247
Practice Address - Country:US
Practice Address - Phone:714-731-4668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30656235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist