Provider Demographics
NPI:1477755726
Name:RACHEK, SALLY A (AUD)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:A
Last Name:RACHEK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8897 MENTOR AVENUE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060
Mailing Address - Country:US
Mailing Address - Phone:440-205-8848
Mailing Address - Fax:440-205-9818
Practice Address - Street 1:8897 MENTOR AVENUE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060
Practice Address - Country:US
Practice Address - Phone:440-205-8848
Practice Address - Fax:440-205-9818
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA0526231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2593420Medicaid