Provider Demographics
NPI:1194272948
Name:GREENE, RACHAEL (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:SCHAFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2127 FIRESTONE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-9508
Mailing Address - Country:US
Mailing Address - Phone:614-563-4862
Mailing Address - Fax:
Practice Address - Street 1:70 HARRISON ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-9226
Practice Address - Country:US
Practice Address - Phone:740-965-7850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH235Z00000X
OHSP13989235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist