Provider Demographics
NPI:1447562731
Name:RATHERT, CARMEN L
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:L
Last Name:RATHERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:CHILHOWEE
Mailing Address - State:MO
Mailing Address - Zip Code:64733
Mailing Address - Country:US
Mailing Address - Phone:660-678-2511
Mailing Address - Fax:660-678-5711
Practice Address - Street 1:101 HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:CHILHOWEE
Practice Address - State:MO
Practice Address - Zip Code:64733
Practice Address - Country:US
Practice Address - Phone:660-678-2511
Practice Address - Fax:660-678-5711
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005026645235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist