Basic Information
| Provider Information | |||||||||
| NPI: | 1245887090 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | RACHAEL | ||||||||
| MiddleName: | MADISON | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9228 LAKE PINE DR | ||||||||
| Address2: | |||||||||
| City: | WHITMORE LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481899368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482029061 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7030 WHITMORE LAKE RD | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481168533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484863636 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2019 | ||||||||
| LastUpdateDate: | 08/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 7101006469 | MI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.