Provider Demographics
NPI:1356984819
Name:BENNETT, RACHEL (CCC-SLP, IBCLC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CCC-SLP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 MONTE CRISTO DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-2322
Mailing Address - Country:US
Mailing Address - Phone:512-228-0088
Mailing Address - Fax:
Practice Address - Street 1:2306 MONTE CRISTO DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-2322
Practice Address - Country:US
Practice Address - Phone:512-228-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113916235Z00000X
TXL-315305174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
174N0000XOtherINTERNATIONAL BOARD CERTIFIED LACTATION CONSULTANT