Provider Demographics
NPI:1396312914
Name:LINDBERG, RACHAL (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:RACHAL
Middle Name:
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:RACHAL
Other - Middle Name:
Other - Last Name:FREGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:150 WESTPARK DR APT 206
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7409
Mailing Address - Country:US
Mailing Address - Phone:218-461-2608
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:204 RESOURCE LN
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-8361
Practice Address - Country:US
Practice Address - Phone:678-963-0694
Practice Address - Fax:888-547-4008
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP011453235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist