Provider Demographics
NPI:1568742443
Name:RAKOWSKI, SUSAN E (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:RAKOWSKI
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 1:4 ICE HOUSE CT
Mailing Address - Street 2:
Mailing Address - City:VERGENNES
Mailing Address - State:VT
Mailing Address - Zip Code:05491-1236
Mailing Address - Country:US
Mailing Address - Phone:802-870-0928
Mailing Address - Fax:802-952-0034
Practice Address - Street 1:4 ICE HOUSE CT
Practice Address - Street 2:
Practice Address - City:VERGENNES
Practice Address - State:VT
Practice Address - Zip Code:05491-1236
Practice Address - Country:US
Practice Address - Phone:802-870-0928
Practice Address - Fax:802-952-0034
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT6-84235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1019602Medicaid