Provider Demographics
NPI:1699141267
Name:YODER, RACHEL ANN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANN
Last Name:YODER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ANN
Other - Last Name:CERULLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1276
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-6276
Mailing Address - Country:US
Mailing Address - Phone:304-842-0044
Mailing Address - Fax:304-842-0033
Practice Address - Street 1:387 HELIPORT LOOP
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-8604
Practice Address - Country:US
Practice Address - Phone:304-842-0044
Practice Address - Fax:304-842-0033
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-1632235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist