Provider Demographics
NPI:1649961731
Name:DORNER, RACHEL L
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:L
Last Name:DORNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:L
Other - Last Name:KINNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:CASCO
Mailing Address - State:WI
Mailing Address - Zip Code:54205-9705
Mailing Address - Country:US
Mailing Address - Phone:920-304-1128
Mailing Address - Fax:920-388-7124
Practice Address - Street 1:810 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:KEWAUNEE
Practice Address - State:WI
Practice Address - Zip Code:54216-1140
Practice Address - Country:US
Practice Address - Phone:920-388-7037
Practice Address - Fax:920-388-7124
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6133235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist