MEDICARE: MRS. RAJAL RANCHOD M.ED., CCC-SLP

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	235Z00000X	Speech-Language Pathologist	SLP005479	GA

General Provider Information

NPI Number	:	1609979921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RAJAL RANCHOD M.ED., CCC-SLP

Provider Business Mailing Address
First Line	:	5960 WILD TIMBER RD
Second Line	:
City	:	SUGAR HILL
State	:	GA
Zip	:	30518-5689
Country	:	US
Telephone Number	:	770-831-7507
Fax Number	:

Provider Business Practice Location Address
First Line	:	5960 WILD TIMBER RD
Second Line	:
City	:	SUGAR HILL
State	:	GA
Zip	:	30518-5689
Country	:	US
Telephone Number	:	770-831-7507
Fax Number	:

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/09/2007

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