Healthcare Provider Details

I. General information

NPI: 1487409165
Provider Name (Legal Business Name): RACHEL ALEXANDER VAQUERANO CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 W BELVEDERE AVE
BALTIMORE MD
21215-5203
US

IV. Provider business mailing address

6013 HUNT RIDGE RD APT 3012
BALTIMORE MD
21210-1113
US

V. Phone/Fax

Practice location:
  • Phone: 410-367-9100
  • Fax:
Mailing address:
  • Phone: 734-846-0772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: