Provider Demographics
NPI:1184740532
Name:KOPRIVNAK, RACHEL (SLP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:KOPRIVNAK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6295 CONLEY RD
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-8860
Mailing Address - Country:US
Mailing Address - Phone:330-322-6062
Mailing Address - Fax:
Practice Address - Street 1:6295 CONLEY RD
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-8860
Practice Address - Country:US
Practice Address - Phone:330-322-6062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP08607235Z00000X
OHSP8607235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist