Provider Demographics
NPI:1346498557
Name:RAKESTRAW, JOHN CHARLES (CCC-CLP/L)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CHARLES
Last Name:RAKESTRAW
Suffix:
Gender:M
Credentials:CCC-CLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GAYS
Mailing Address - State:IL
Mailing Address - Zip Code:61928-9784
Mailing Address - Country:US
Mailing Address - Phone:217-254-6895
Mailing Address - Fax:
Practice Address - Street 1:1204 N 1ST ST
Practice Address - Street 2:
Practice Address - City:GAYS
Practice Address - State:IL
Practice Address - Zip Code:61928-9784
Practice Address - Country:US
Practice Address - Phone:217-254-6895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146004265235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist