Healthcare Provider Details

I. General information

NPI: 1851949150
Provider Name (Legal Business Name): RACHEL NICOLE SMIETANSKI M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL NICOLE WEIS

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 E 2ND ST
LOCKPORT IL
60441-2907
US

IV. Provider business mailing address

419 E 2ND ST
LOCKPORT IL
60441-2907
US

V. Phone/Fax

Practice location:
  • Phone: 815-735-8199
  • Fax:
Mailing address:
  • Phone: 815-735-8199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146015491
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: