=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124485065
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL FIELDER MS, CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2016
-----------------------------------------------------
Last Update Date | 01/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 472 KAULANA ST
-----------------------------------------------------
City | KAHULUI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96732-2050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-877-2761
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1544 MOCKINGBIRD DR
-----------------------------------------------------
City | MURRAY
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42071-3279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-703-3989
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 1529
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 4066
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------