Provider Demographics
NPI:1154179380
Name:WALSH, RACQUEL LAUREN (CF-SLP)
Entity type:Individual
Prefix:MS
First Name:RACQUEL
Middle Name:LAUREN
Last Name:WALSH
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 DEER RD
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4965
Mailing Address - Country:US
Mailing Address - Phone:631-624-6009
Mailing Address - Fax:
Practice Address - Street 1:1116 MAIN RD
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-5724
Practice Address - Country:US
Practice Address - Phone:631-624-6009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist