Healthcare Provider Details

I. General information

NPI: 1467385146
Provider Name (Legal Business Name): RACHEL NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 11TH AVE
DE WITT IA
52742-1025
US

IV. Provider business mailing address

1108 11TH AVE
DE WITT IA
52742-1025
US

V. Phone/Fax

Practice location:
  • Phone: 563-293-1655
  • Fax: 563-205-5393
Mailing address:
  • Phone: 563-293-1655
  • Fax: 563-205-5393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number132731
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: