Provider Demographics
NPI:1225621238
Name:ANDERTON, RACHEL THOMAS (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:THOMAS
Last Name:ANDERTON
Suffix:
Gender:
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:KATHRYN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 BRIERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7767
Mailing Address - Country:US
Mailing Address - Phone:601-218-7238
Mailing Address - Fax:
Practice Address - Street 1:205 INDUSTRIAL CV
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2715
Practice Address - Country:US
Practice Address - Phone:877-407-3422
Practice Address - Fax:877-407-4329
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS-4349235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist