MEDICARE: JOE RAUSCHENBACH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YS0200X	School Counselor

General Provider Information

NPI Number	:	1013138510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOE RAUSCHENBACH

Provider Business Mailing Address
First Line	:	2625 E HEIDI LOOP
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86004-1845
Country	:	US
Telephone Number	:	928-526-9314
Fax Number	:

Provider Business Practice Location Address
First Line	:	7150 SILVER SADDLE RD
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86004-3207
Country	:	US
Telephone Number	:	928-527-3873
Fax Number	:	928-526-8985

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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Directions to “ JOE RAUSCHENBACH ” Practice Location

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