Provider Demographics
NPI:1023420015
Name:MASSA, RACHEL LAUREN (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LAUREN
Last Name:MASSA
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 1:1722 NORMAN RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5965
Mailing Address - Country:US
Mailing Address - Phone:618-978-0349
Mailing Address - Fax:
Practice Address - Street 1:411 S COURT ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-2711
Practice Address - Country:US
Practice Address - Phone:618-993-2138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.012188235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist