Healthcare Provider Details

I. General information

NPI: 1386085819
Provider Name (Legal Business Name): RACHEL DEUTSCH CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL SPITZ CCC-SLP

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 HEWLETT ST
WATERBURY CT
06710-1615
US

IV. Provider business mailing address

40 HEWLETT ST
WATERBURY CT
06710-1615
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-0782
  • Fax:
Mailing address:
  • Phone: 203-573-0782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number014229
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: