Provider Demographics
NPI:1740328384
Name:STOTTS, RACHEL LYNN
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LYNN
Last Name:STOTTS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:LYNN
Other - Last Name:REESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2883 26TH STREET CIR S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5353
Mailing Address - Country:US
Mailing Address - Phone:218-287-1184
Mailing Address - Fax:701-232-2330
Practice Address - Street 1:10318 6TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8116
Practice Address - Country:US
Practice Address - Phone:701-238-3908
Practice Address - Fax:701-232-2330
Is Sole Proprietor?:No
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND966235Z00000X
MN8118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND51269Medicaid
ND27353Medicare UPIN