Healthcare Provider Details

I. General information

NPI: 1538553672
Provider Name (Legal Business Name): RACHEAL HOVLAND MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W CHARLOTTE ST
RIVER FALLS WI
54022-2847
US

IV. Provider business mailing address

310 W CHARLOTTE ST
RIVER FALLS WI
54022-2847
US

V. Phone/Fax

Practice location:
  • Phone: 715-426-2047
  • Fax:
Mailing address:
  • Phone: 715-426-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2753-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: