MEDICARE: RACHEL LYN IRUEGAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	110519	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063173888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL LYN IRUEGAS

Provider Business Mailing Address
First Line	:	7112 JESSUP CT
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-2043
Country	:	US
Telephone Number	:	956-763-7093
Fax Number	:

Provider Business Practice Location Address
First Line	:	6601 CLOVERHAVEN WAY
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-8988
Country	:	US
Telephone Number	:	469-752-4514
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2022
Last Update Date	:	01/04/2022

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Directions to “ RACHEL LYN IRUEGAS ” Practice Location

Language	Start Address	Practice Location

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