MEDICARE: RACHEL RAVITCH

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	SL010506	PA

General Provider Information

NPI Number	:	1740573401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL RAVITCH

Provider Business Mailing Address
First Line	:	425 MONROE ST
Second Line	:	APT 3
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-3117
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 MONROE ST
Second Line	:	APT 3
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-3117
Country	:	US
Telephone Number	:	215-570-1545
Fax Number	:

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

Provider Enumeration Date	:	05/26/2011
Last Update Date	:	02/20/2012

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Directions to “ RACHEL RAVITCH ” Practice Location

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