Provider Demographics
NPI:1982659033
Name:MASON, RACHEL J (EDD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:J
Last Name:MASON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4172 BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-5003
Mailing Address - Country:US
Mailing Address - Phone:843-423-4917
Mailing Address - Fax:843-423-9928
Practice Address - Street 1:500 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-3032
Practice Address - Country:US
Practice Address - Phone:843-423-9998
Practice Address - Fax:843-423-9928
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2097235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2097OtherLICENSE NUMBER
SCSA0045Medicaid
SC01034437OtherAMERICAN SPEECH & HEARING