Healthcare Provider Details

I. General information

NPI: 1053866848
Provider Name (Legal Business Name): RACHEL COY HUTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13501 NE 28TH ST
VANCOUVER WA
98682-8091
US

IV. Provider business mailing address

13501 NE 28TH ST
VANCOUVER WA
98682-8091
US

V. Phone/Fax

Practice location:
  • Phone: 306-604-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number530246H
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: