Provider Demographics
NPI:1104481258
Name:GARRETT, RACHEL ETHRIDGE (CLC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ETHRIDGE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LAUREN
Other - Last Name:ETHRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:144 BREWERS OAK LN
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3374
Mailing Address - Country:US
Mailing Address - Phone:864-580-3789
Mailing Address - Fax:
Practice Address - Street 1:144 BREWERS OAK LN
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3374
Practice Address - Country:US
Practice Address - Phone:864-580-3789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN