Provider Demographics
NPI:1215430574
Name:CLEMENTS, RACHEL KATHLEEN (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:KATHLEEN
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:KATHLEEN
Other - Last Name:CLEMENTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:911 N GOLIAD ST
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-2230
Mailing Address - Country:US
Mailing Address - Phone:469-458-9021
Mailing Address - Fax:866-693-6509
Practice Address - Street 1:911 N GOLIAD ST
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-2230
Practice Address - Country:US
Practice Address - Phone:469-458-9021
Practice Address - Fax:866-693-6509
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110433235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist