Provider Demographics
NPI:1063764793
Name:WAISSMAN, RACHAEL (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:RACHAEL
Middle Name:
Last Name:WAISSMAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4122 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-4017
Mailing Address - Country:US
Mailing Address - Phone:253-879-1026
Mailing Address - Fax:253-571-2717
Practice Address - Street 1:601 S. 8TH STREET
Practice Address - Street 2:TACOMA PUBLIC SCHOOLS
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4011
Practice Address - Country:US
Practice Address - Phone:253-571-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001196235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALL00001196Medicaid