Healthcare Provider Details

I. General information

NPI: 1790619658
Provider Name (Legal Business Name): RACHEL ROOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 14TH AVE
NEW GLARUS WI
53574-9796
US

IV. Provider business mailing address

1001 WILD WILLOW WAY APT 202
VERONA WI
53593-8184
US

V. Phone/Fax

Practice location:
  • Phone: 608-527-2410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number852461
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4876-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: