Provider Demographics
NPI:1528678307
Name:MOYERS, RACHELLE LENAE (MED, MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:LENAE
Last Name:MOYERS
Suffix:
Gender:F
Credentials:MED, MS CCC-SLP
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:NOBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1670 WHIPPOORWILL LN
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72713-8481
Mailing Address - Country:US
Mailing Address - Phone:949-285-7016
Mailing Address - Fax:
Practice Address - Street 1:847 S DOGWOOD ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3915
Practice Address - Country:US
Practice Address - Phone:479-524-3191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR201167235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist