Provider Demographics
NPI:1356918510
Name:LOOK, RACHAEL MARY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:MARY
Last Name:LOOK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 PORTLAND AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-6805
Mailing Address - Country:US
Mailing Address - Phone:952-428-0400
Mailing Address - Fax:
Practice Address - Street 1:12400 PORTLAND AVE STE 140
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6805
Practice Address - Country:US
Practice Address - Phone:952-428-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5245235Z00000X
MN518226235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN518226OtherMN STATE LICENSE NUMBER