Provider Demographics
NPI:1871016543
Name:ACKERMAN, RACHAEL FRANCES LINDGREN
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:FRANCES LINDGREN
Last Name:ACKERMAN
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 1:4463 EDSALL DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193
Mailing Address - Country:US
Mailing Address - Phone:765-438-9487
Mailing Address - Fax:
Practice Address - Street 1:2106 GALLOWS RD # G
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3961
Practice Address - Country:US
Practice Address - Phone:571-766-8455
Practice Address - Fax:703-665-1241
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008226235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist