Provider Demographics
NPI:1336761568
Name:CANNON, RACHEL N
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:N
Last Name:CANNON
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 1:5944 HEBER SPRINGS RD N
Mailing Address - Street 2:
Mailing Address - City:IDA
Mailing Address - State:AR
Mailing Address - Zip Code:72546-9368
Mailing Address - Country:US
Mailing Address - Phone:870-668-4059
Mailing Address - Fax:
Practice Address - Street 1:1000 WHITE DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-2001
Practice Address - Country:US
Practice Address - Phone:870-569-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist