Healthcare Provider Details

I. General information

NPI: 1750629002
Provider Name (Legal Business Name): RACHEL MARIE CONRAD MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1861 N. ROCK RD STE 101
WICHITA KS
67206
US

IV. Provider business mailing address

1861 N. ROCK RD STE 101
WICHITA KS
67206
US

V. Phone/Fax

Practice location:
  • Phone: 316-295-6845
  • Fax: 316-558-5361
Mailing address:
  • Phone: 316-295-6845
  • Fax: 316-558-5361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4435
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: