Provider Demographics
NPI:1073663357
Name:QUAM, RACHEL MARIE (MSCCCSLP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:QUAM
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 7TH ST NE
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-2530
Mailing Address - Country:US
Mailing Address - Phone:701-347-1188
Mailing Address - Fax:701-402-5154
Practice Address - Street 1:412 7TH ST NE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2530
Practice Address - Country:US
Practice Address - Phone:701-347-1188
Practice Address - Fax:701-401-5154
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND742235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1459138Medicaid