Provider Demographics
NPI:1750733101
Name:TYE, RACHEL (CCC-SLP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:TYE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 MASSACHUSETTS AVE
Mailing Address - Street 2:APARTMENT 2
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4231
Mailing Address - Country:US
Mailing Address - Phone:978-979-1946
Mailing Address - Fax:
Practice Address - Street 1:1230 MASSACHUSETTS AVE
Practice Address - Street 2:APARTMENT 2
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4231
Practice Address - Country:US
Practice Address - Phone:978-979-1946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9221235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist