Provider Demographics
NPI:1366688954
Name:RASCHKE, JEANNE MARTHA (EDUCATIONAL DR)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARTHA
Last Name:RASCHKE
Suffix:
Gender:F
Credentials:EDUCATIONAL DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 FAYE CIR N
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1512
Mailing Address - Country:US
Mailing Address - Phone:863-646-8451
Mailing Address - Fax:
Practice Address - Street 1:315 FAYE CIR N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1512
Practice Address - Country:US
Practice Address - Phone:863-646-8451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS536174400000X
FLSS 536174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist