Provider Demographics
NPI:1417008939
Name:LOZANO, RACHEL DIANE (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:DIANE
Last Name:LOZANO
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3461 E RIOPELLE AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-9107
Mailing Address - Country:US
Mailing Address - Phone:480-629-5911
Mailing Address - Fax:480-696-4945
Practice Address - Street 1:3461 E RIOPELLE AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-9107
Practice Address - Country:US
Practice Address - Phone:480-629-5911
Practice Address - Fax:480-696-4945
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11375235Z00000X
AZ4205235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
09128011OtherASHA
CA11375OtherSLP LICENSE
AZ4205OtherSLP LICENSE