Provider Demographics
NPI:1124646567
Name:HEATH, RACHEL MARIE (SLP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:HEATH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:MARIE
Other - Last Name:SULLIVAN-HEATH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:652 HENDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-1531
Mailing Address - Country:US
Mailing Address - Phone:646-724-0562
Mailing Address - Fax:
Practice Address - Street 1:309 ST PAULS AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2217
Practice Address - Country:US
Practice Address - Phone:718-727-8202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist