Provider Demographics
NPI:1740859701
Name:KIM, RACHEL EUNBEE (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:EUNBEE
Last Name:KIM
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43540 LUCKETTS BRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-6716
Mailing Address - Country:US
Mailing Address - Phone:571-229-2956
Mailing Address - Fax:
Practice Address - Street 1:14135 ROBERT PARIS CT
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-4203
Practice Address - Country:US
Practice Address - Phone:703-821-1363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000784235Z00000X
DCSLPCF0000007235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist