Healthcare Provider Details

I. General information

NPI: 1467528539
Provider Name (Legal Business Name): RACHEL WHORTON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 N LAURA ST
JACKSONVILLE FL
32206-4912
US

IV. Provider business mailing address

1128 N LAURA ST
JACKSONVILLE FL
32206-4912
US

V. Phone/Fax

Practice location:
  • Phone: 904-355-3403
  • Fax: 904-355-4149
Mailing address:
  • Phone: 904-355-3403
  • Fax: 904-355-4149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 6586
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: