Provider Demographics
NPI:1417294307
Name:FLEMING, RAEANN MARIE (MA, SLP, ESA)
Entity Type:Individual
Prefix:
First Name:RAEANN
Middle Name:MARIE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:MA, SLP, ESA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W CLARK RD # 829
Mailing Address - Street 2:
Mailing Address - City:CONNELL
Mailing Address - State:WA
Mailing Address - Zip Code:99326-9700
Mailing Address - Country:US
Mailing Address - Phone:509-234-9218
Mailing Address - Fax:509-234-9204
Practice Address - Street 1:1100 W CLARK RD # 829
Practice Address - Street 2:
Practice Address - City:CONNELL
Practice Address - State:WA
Practice Address - Zip Code:99326-9700
Practice Address - Country:US
Practice Address - Phone:509-234-9218
Practice Address - Fax:509-234-9204
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA367286B235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA367286BOtherEDUCATIONAL STAFF ASSOCIATE, SCHOOL SPEECH LANGUAGE PATHOLOGIST