Provider Demographics
NPI:1013313139
Name:MAUER, RACHELLE
Entity Type:Individual
Prefix:MS
First Name:RACHELLE
Middle Name:
Last Name:MAUER
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 1:60 SOAP ST
Mailing Address - Street 2:
Mailing Address - City:DAYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06241-1622
Mailing Address - Country:US
Mailing Address - Phone:617-413-7425
Mailing Address - Fax:
Practice Address - Street 1:60 SOAP ST
Practice Address - Street 2:
Practice Address - City:DAYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06241-1622
Practice Address - Country:US
Practice Address - Phone:617-413-7425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004261235Z00000X
MA8202235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist