Healthcare Provider Details

I. General information

NPI: 1922291095
Provider Name (Legal Business Name): RACHEL RAE BENDING M.S. CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL RAE STOBBE M.S. CCC-A

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 RICKMEYER DR STE. CC
FOND DU LAC WI
54937-2213
US

IV. Provider business mailing address

140 CORPORATE DR STE. 1
BEAVER DAM WI
53916-1281
US

V. Phone/Fax

Practice location:
  • Phone: 920-922-6640
  • Fax:
Mailing address:
  • Phone: 920-887-9655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number442-156
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: