Provider Demographics
NPI:1013627223
Name:PASS, RACHEL
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:PASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6030 BETHELVIEW RD STE 303
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-8023
Mailing Address - Country:US
Mailing Address - Phone:678-205-5437
Mailing Address - Fax:678-261-0065
Practice Address - Street 1:6030 BETHELVIEW RD STE 303
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8023
Practice Address - Country:US
Practice Address - Phone:678-205-5437
Practice Address - Fax:678-261-0065
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2023-01-18
Deactivation Date:2022-12-20
Deactivation Code:
Reactivation Date:2023-01-11
Provider Licenses
StateLicense IDTaxonomies
GAPCET003552235Z00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program