Provider Demographics
NPI:1043571375
Name:MCCRANIE, RACHELLE NICHOLSON (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:NICHOLSON
Last Name:MCCRANIE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 ROSA CT
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-7836
Mailing Address - Country:US
Mailing Address - Phone:904-315-4265
Mailing Address - Fax:
Practice Address - Street 1:362 ROSA CT
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-7836
Practice Address - Country:US
Practice Address - Phone:904-315-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5011235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist