MEDICARE: RACHEL RIELY MS, CCC-SLP

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	SP13346	CA

General Provider Information

NPI Number	:	1366056798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL RIELY MS, CCC-SLP

Provider Business Mailing Address
First Line	:	803 BRADDOCK CT
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95618-4952
Country	:	US
Telephone Number	:	530-574-2073
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 PALM AVE
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95695-2844
Country	:	US
Telephone Number	:	530-661-0574
Fax Number	:

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

Provider Enumeration Date	:	09/02/2020
Last Update Date	:	09/02/2020

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