Healthcare Provider Details

I. General information

NPI: 1598558231
Provider Name (Legal Business Name): RACHAEL DANIELLE KOFOD M.S., CCC-SLP/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 CHESTNUT ST
FREDONIA NY
14063-1649
US

IV. Provider business mailing address

PO BOX 876
SINCLAIRVILLE NY
14782-0876
US

V. Phone/Fax

Practice location:
  • Phone: 716-679-1581
  • Fax:
Mailing address:
  • Phone: 716-467-1049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: