Provider Demographics
NPI:1013627223
Name:PASS, RACHEL (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:PASS
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4992 BRISTOL INDUSTRIAL WAY
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-1742
Mailing Address - Country:US
Mailing Address - Phone:770-904-6419
Mailing Address - Fax:
Practice Address - Street 1:4992 BRISTOL INDUSTRIAL WAY
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-1742
Practice Address - Country:US
Practice Address - Phone:770-904-6419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2025-07-14
Deactivation Date:2022-12-20
Deactivation Code:
Reactivation Date:2023-01-11
Provider Licenses
StateLicense IDTaxonomies
GASLP012737235Z00000X
GAPCET003552390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program