Provider Demographics
NPI:1912259649
Name:NOLAN, RACHEL DIANE
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:DIANE
Last Name:NOLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:DIANE
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6700 S KEATING AVE
Mailing Address - Street 2:#914
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5660
Mailing Address - Country:US
Mailing Address - Phone:773-767-6262
Mailing Address - Fax:
Practice Address - Street 1:6700 S KEATING AVE
Practice Address - Street 2:#914
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5660
Practice Address - Country:US
Practice Address - Phone:773-767-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146011364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist