MEDICARE: RAEGEN DALTON

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	175T00000X	Peer Specialist		OH

General Provider Information

NPI Number	:	1013860543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAEGEN DALTON

Provider Business Mailing Address
First Line	:	24336 SMITH AVE
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-4817
Country	:	US
Telephone Number	:	216-409-3656
Fax Number	:

Provider Business Practice Location Address
First Line	:	24336 SMITH AVE
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-4817
Country	:	US
Telephone Number	:	216-409-3656
Fax Number	:

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

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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Directions to “ RAEGEN DALTON ” Practice Location

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