Provider Demographics
NPI:1922291095
Name:BENDING, RACHEL RAE (MS CCC-A)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:RAE
Last Name:BENDING
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:RAE
Other - Last Name:STOBBE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC-A
Mailing Address - Street 1:140 CORPORATE DR
Mailing Address - Street 2:STE. 1
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-1281
Mailing Address - Country:US
Mailing Address - Phone:920-887-9655
Mailing Address - Fax:
Practice Address - Street 1:1211 RICKMEYER DR
Practice Address - Street 2:STE. CC
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54937-2213
Practice Address - Country:US
Practice Address - Phone:920-922-6640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI442-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41147400Medicaid