Provider Demographics
NPI:1588237028
Name:WHITAKER BROWN, RAYCHEL GENEE
Entity Type:Individual
Prefix:
First Name:RAYCHEL
Middle Name:GENEE
Last Name:WHITAKER BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N EWING ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MO
Mailing Address - Zip Code:64644-1156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:419 S HUGHES ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MO
Practice Address - Zip Code:64644-1352
Practice Address - Country:US
Practice Address - Phone:816-583-2134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021022077235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist