Provider Demographics
NPI:1194887232
Name:CREECH, RACHEL MOUROT (SLP)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:MOUROT
Last Name:CREECH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 RACHEL DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-8596
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:289 HIGHWAY 287
Practice Address - Street 2:
Practice Address - City:PLUMERVILLE
Practice Address - State:AR
Practice Address - Zip Code:72127-8866
Practice Address - Country:US
Practice Address - Phone:501-208-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2401235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARSP#2401OtherABESPA
AR12090045OtherASHA