Provider Demographics
NPI:1578765913
Name:RAJALA, JAMES STEVEN (CCC SLP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:STEVEN
Last Name:RAJALA
Suffix:
Gender:M
Credentials: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:BOX 451
Mailing Address - Street 2:40299 THORSON DRIVE
Mailing Address - City:PIGEON FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54760-0451
Mailing Address - Country:US
Mailing Address - Phone:715-983-2197
Mailing Address - Fax:
Practice Address - Street 1:40299 THORSON DRIVE
Practice Address - Street 2:
Practice Address - City:PIGEON FALLS
Practice Address - State:WI
Practice Address - Zip Code:54760-0451
Practice Address - Country:US
Practice Address - Phone:715-983-2197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171 154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42743600Medicaid