Provider Demographics
NPI:1609455435
Name:HARROUK, RACQUEL A (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RACQUEL
Middle Name:A
Last Name:HARROUK
Suffix:
Gender:F
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 1:20000 VICTOR PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-7027
Mailing Address - Country:US
Mailing Address - Phone:734-743-2909
Mailing Address - Fax:
Practice Address - Street 1:20000 VICTOR PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-7027
Practice Address - Country:US
Practice Address - Phone:734-743-2909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7151000329235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist