Provider Demographics
NPI:1740438522
Name:YANCEY, RACHEL ANN (MACCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ANN
Last Name:YANCEY
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ANN
Other - Last Name:FAUST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MACCC-SLP
Mailing Address - Street 1:100 CAMPUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72342
Mailing Address - Country:US
Mailing Address - Phone:870-338-6461
Mailing Address - Fax:870-338-8442
Practice Address - Street 1:100 CAMPUS DRIVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342
Practice Address - Country:US
Practice Address - Phone:870-338-6461
Practice Address - Fax:870-338-8442
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#36235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116838721Medicaid