Provider Demographics
NPI:1134434657
Name:MAYNARD, RACHEL (MA, CCC-SLP, IBCLC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:MA, CCC-SLP, IBCLC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:DORR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19021 120TH AVE NE STE 102
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-9511
Mailing Address - Country:US
Mailing Address - Phone:425-486-7710
Mailing Address - Fax:
Practice Address - Street 1:19021 120TH AVE NE STE 102
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-9511
Practice Address - Country:US
Practice Address - Phone:425-486-7710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAL-307335174N00000X
CA18489235Z00000X
WA60919825235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN