Provider Demographics
NPI:1831741826
Name:GALLENBACH, RACHEL M (CCC-SLP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:M
Last Name:GALLENBACH
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 1:48 BESHEARS LN
Mailing Address - Street 2:
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42044-8938
Mailing Address - Country:US
Mailing Address - Phone:618-713-2069
Mailing Address - Fax:
Practice Address - Street 1:4645 VILLAGE SQUARE DR STE A
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7448
Practice Address - Country:US
Practice Address - Phone:618-713-2069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251591235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist