Basic Information
| Provider Information | |||||||||
| NPI: | 1043468044 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREEN | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2820 STONEWAY LN | ||||||||
| Address2: | APT B | ||||||||
| City: | FORT PIERCE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349824340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7724618562 | ||||||||
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| Practice Location | |||||||||
| Address1: | 787 37TH ST | ||||||||
| Address2: | SUITE E-100 | ||||||||
| City: | VERO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329607305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7725670061 | ||||||||
| FaxNumber: | 7725670062 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2008 | ||||||||
| LastUpdateDate: | 09/03/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2355S0801X | SI1570 | FL | Y | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant |
No ID Information.