Provider Demographics
NPI:1790459931
Name:DALE, RAINA MAHEALANI (MSD CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:RAINA
Middle Name:MAHEALANI
Last Name:DALE
Suffix:
Gender:F
Credentials:MSD CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67-1185 MAMALAHOA HWY D104
Mailing Address - Street 2:PMB 135
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743
Mailing Address - Country:US
Mailing Address - Phone:808-345-9410
Mailing Address - Fax:
Practice Address - Street 1:45-527 PAKALANA ST
Practice Address - Street 2:
Practice Address - City:HONOKAA
Practice Address - State:HI
Practice Address - Zip Code:96727-6986
Practice Address - Country:US
Practice Address - Phone:808-345-9410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP-1723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist