MEDICARE: RACHEL MARIE FANCHER

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

General Provider Information

NPI Number	:	1558780437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL MARIE FANCHER

Provider Business Mailing Address
First Line	:	5219 MAPLE AVE
Second Line	:	APT 1105
City	:	DALLAS
State	:	TX
Zip	:	75235-7433
Country	:	US
Telephone Number	:	404-520-7206
Fax Number	:

Provider Business Practice Location Address
First Line	:	5219 MAPLE AVE
Second Line	:	APT 1105
City	:	DALLAS
State	:	TX
Zip	:	75235-7433
Country	:	US
Telephone Number	:	404-520-7206
Fax Number	:

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

Provider Enumeration Date	:	04/08/2014
Last Update Date	:	04/08/2014

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Directions to “ RACHEL MARIE FANCHER ” Practice Location

Language	Start Address	Practice Location

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