Provider Demographics
NPI:1124264346
Name:RYAN, RACHEL (SLP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 COLLEGE DR # 5215
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39406-0002
Mailing Address - Country:US
Mailing Address - Phone:601-266-5223
Mailing Address - Fax:601-266-6763
Practice Address - Street 1:118 COLLEGE DR # 5215
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39406-0002
Practice Address - Country:US
Practice Address - Phone:601-266-5223
Practice Address - Fax:601-266-6763
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSS3169OtherMS STATE BOARD OF HEALTH