Provider Demographics
NPI:1366525008
Name:COX, RACHEAL ANNE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:RACHEAL
Middle Name:ANNE
Last Name:COX
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5223 FM 2087 S
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-6961
Mailing Address - Country:US
Mailing Address - Phone:903-445-5676
Mailing Address - Fax:903-753-8502
Practice Address - Street 1:3110 PARK CENTER DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9215
Practice Address - Country:US
Practice Address - Phone:903-593-9999
Practice Address - Fax:903-526-2679
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103004235Z00000X
TX12154887235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX376926YTE5Medicare UPIN