Provider Demographics
NPI:1558852970
Name:PROCTOR, RAQUEL MARIE (AUD)
Entity Type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:MARIE
Last Name:PROCTOR
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 1:2226 HOLIDAY MANOR CTR STE 4
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-6407
Mailing Address - Country:US
Mailing Address - Phone:502-632-1460
Mailing Address - Fax:502-632-1460
Practice Address - Street 1:2226 HOLIDAY MANOR CTR STE 4
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-6407
Practice Address - Country:US
Practice Address - Phone:502-632-1460
Practice Address - Fax:502-632-1460
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY242363231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist