Basic Information
Provider Information
NPI: 1053967729
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SPINUZZA
FirstName: RACHEL
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: AUD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4320 SUWANEE DAM RD STE 200
Address2:  
City: SUWANEE
State: GA
PostalCode: 300241951
CountryCode: US
TelephoneNumber: 4042974320
FaxNumber: 6787109430
Practice Location
Address1: 3607 MANOR RD STE 101
Address2:  
City: AUSTIN
State: TX
PostalCode: 787235818
CountryCode: US
TelephoneNumber: 5124782273
FaxNumber: 5124720921
Other Information
ProviderEnumerationDate: 08/17/2019
LastUpdateDate: 09/28/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/28/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
231H00000X81211TXY Speech, Language and Hearing Service ProvidersAudiologist 
231H00000XAUD004205GAN Speech, Language and Hearing Service ProvidersAudiologist 

No ID Information.


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