Provider Demographics
NPI:1518123728
Name:FRY, RACHEL (RACHEL FRY)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:FRY
Suffix:
Gender:F
Credentials:RACHEL FRY
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:KIBLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:1350 THERNS FERRY DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-0268
Mailing Address - Country:US
Mailing Address - Phone:716-400-4569
Mailing Address - Fax:
Practice Address - Street 1:1350 THERNS FERRY DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-0268
Practice Address - Country:US
Practice Address - Phone:716-400-4569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2024-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018142-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist