Basic Information
| Provider Information | |||||||||
| NPI: | 1982796595 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUBE RAINIER | ||||||||
| FirstName: | JEAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.ED, CCC/SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38 LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033012934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032250800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 170 WARREN ST | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033012942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032250800 | ||||||||
| FaxNumber: | 6035473571 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 08/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 0494 | NH | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 30400663 | 05 | NH | MEDICAID |