1427103001 NPI number — MRS. RACHAEL MARY WALDEN M.S./ SLP

Table of content: MRS. RACHAEL MARY WALDEN M.S./ SLP (NPI 1427103001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427103001 NPI number — MRS. RACHAEL MARY WALDEN M.S./ SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALDEN
Provider First Name:
RACHAEL
Provider Middle Name:
MARY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S./ SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LANNOM
Provider Other First Name:
RACHAEL
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S./SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427103001
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1155 MILL ST
Provider Second Line Business Mailing Address:
MS M14
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89502-1576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-982-5262
Provider Business Mailing Address Fax Number:
775-982-3900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1664 N VIRGINIA ST MAIL STOP 152
Provider Second Line Business Practice Location Address:
REDFIELD MEDICAL BLDG
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89557-0152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-784-4887
Provider Business Practice Location Address Fax Number:
775-784-4095
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SP-725 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100500895 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: SP#725 . This is a "BOARD OF EXAMINERS" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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