Provider Demographics
NPI:1194240259
Name:SISK, RACHEL MARSTON (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARSTON
Last Name:SISK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 PINE CIR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-4015
Mailing Address - Country:US
Mailing Address - Phone:931-279-2597
Mailing Address - Fax:
Practice Address - Street 1:1311 S LOCUST AVE STE 101
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4054
Practice Address - Country:US
Practice Address - Phone:931-766-6374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6019235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist