Provider Demographics
NPI:1114283900
Name:STROMBERG, RAINA LYNN (AUD)
Entity Type:Individual
Prefix:
First Name:RAINA
Middle Name:LYNN
Last Name:STROMBERG
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 CHARWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-2718
Mailing Address - Country:US
Mailing Address - Phone:330-604-2697
Mailing Address - Fax:
Practice Address - Street 1:2365 CLINTON AVE S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2663
Practice Address - Country:US
Practice Address - Phone:585-758-5700
Practice Address - Fax:585-758-1297
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002396231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1346285657Medicaid
NY1346285657Medicare UPIN
NY1346285657Medicare NSC
NY1346285657Medicaid
NY1346285657Medicare Oscar/Certification