Provider Demographics
NPI:1922649052
Name:MOON, RACHEL (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N WASHINGTON ST STE 320
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-5506
Mailing Address - Country:US
Mailing Address - Phone:570-401-8124
Mailing Address - Fax:703-677-8130
Practice Address - Street 1:901 N WASHINGTON ST STE 320
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-5506
Practice Address - Country:US
Practice Address - Phone:570-401-8124
Practice Address - Fax:703-677-8130
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000407235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist