Provider Demographics
NPI:1700417813
Name:LANDRY, RACHEL (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:LANDRY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 FAIRMOUNT AVE # A
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1152
Mailing Address - Country:US
Mailing Address - Phone:831-713-8238
Mailing Address - Fax:
Practice Address - Street 1:9057 SOQUEL DRIVE
Practice Address - Street 2:BUILDING A, SUITE CC
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003
Practice Address - Country:US
Practice Address - Phone:831-471-7344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP27512235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist