Provider Demographics
NPI:1811275159
Name:GIACONTIERE, RACHEL FITZMORRIS (AUD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:FITZMORRIS
Last Name:GIACONTIERE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:FITZMORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1420 N CAUSEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3104
Mailing Address - Country:US
Mailing Address - Phone:985-327-5905
Mailing Address - Fax:985-200-1305
Practice Address - Street 1:1420 N CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3104
Practice Address - Country:US
Practice Address - Phone:985-327-5905
Practice Address - Fax:985-200-1305
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6486231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2177257Medicaid
LA3C6077061Medicare PIN