Provider Demographics
NPI:1710485206
Name:MENDOZA, RACHEL STEPHANIE (SLPA)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:STEPHANIE
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10061 E SUSAN RAE PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-6723
Mailing Address - Country:US
Mailing Address - Phone:520-444-0343
Mailing Address - Fax:
Practice Address - Street 1:10061 E SUSAN RAE PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-6723
Practice Address - Country:US
Practice Address - Phone:520-444-0343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0416Medicaid