1104593037 NPI number — MRS. RACHEL ALLISON DONALDSON

Table of content: MRS. RACHEL ALLISON DONALDSON (NPI 1104593037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104593037 NPI number — MRS. RACHEL ALLISON DONALDSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONALDSON
Provider First Name:
RACHEL
Provider Middle Name:
ALLISON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104593037
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1524 CHESTERLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44107-4824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-235-4340
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2601 POLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LORAIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44052-4303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-830-4041
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2021

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:  COND.20211830-SP , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: OH3391167 . This is a "OHIO BOARD OF EDUCATION - 5-YEAR PUPIL SERVICES" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: COND.20211830-SP . This is a "OHIO SPEECH AND HEARING PROFESSIONALS BOARD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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