Provider Demographics
NPI:1871222034
Name:DORAN, RACHEL (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:DORAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2377 SE MONROE ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-5840
Mailing Address - Country:US
Mailing Address - Phone:630-272-4609
Mailing Address - Fax:
Practice Address - Street 1:2377 SE MONROE ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-5840
Practice Address - Country:US
Practice Address - Phone:630-272-4609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-05
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA15592235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist