Basic Information
| Provider Information | |||||||||
| NPI: | 1811664410 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RASCOP | ||||||||
| FirstName: | RACHAEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 712 HARVARD DR | ||||||||
| Address2: | |||||||||
| City: | EDWARDSVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620252672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7082886700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3523 WICKENHAUSER AVE | ||||||||
| Address2: | |||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620022118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184658887 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2021 | ||||||||
| LastUpdateDate: | 08/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 242.006238 | IL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.