Provider Demographics
NPI:1396259131
Name:RAKOWSKI, ANNA M (MS CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:RAKOWSKI
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7N186 GLEN RD
Mailing Address - Street 2:
Mailing Address - City:MEDINAH
Mailing Address - State:IL
Mailing Address - Zip Code:60157-9636
Mailing Address - Country:US
Mailing Address - Phone:847-414-3758
Mailing Address - Fax:
Practice Address - Street 1:170 S WOOD DALE RD
Practice Address - Street 2:
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-2271
Practice Address - Country:US
Practice Address - Phone:630-766-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010316235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist