Provider Demographics
NPI:1508265596
Name:PERSAD-MAHARAJ, RAELENE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RAELENE
Middle Name:
Last Name:PERSAD-MAHARAJ
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 E ROYALTON RD
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-2827
Mailing Address - Country:US
Mailing Address - Phone:440-584-9430
Mailing Address - Fax:
Practice Address - Street 1:2801 E ROYALTON RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2827
Practice Address - Country:US
Practice Address - Phone:440-584-9430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 9828235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist