Provider Demographics
NPI:1750629002
Name:CONRAD, RACHEL MARIE (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:MARIE
Last Name:CONRAD
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 N. ROCK RD
Mailing Address - Street 2:STE 101
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206
Mailing Address - Country:US
Mailing Address - Phone:316-295-6845
Mailing Address - Fax:316-558-5361
Practice Address - Street 1:1861 N. ROCK RD
Practice Address - Street 2:STE 101
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206
Practice Address - Country:US
Practice Address - Phone:316-295-6845
Practice Address - Fax:316-558-5361
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
KS4435235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator