Provider Demographics
NPI:1194544296
Name:BEITLER, RACHEL N/A
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:N/A
Last Name:BEITLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 PENNINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3406
Mailing Address - Country:US
Mailing Address - Phone:201-421-8748
Mailing Address - Fax:
Practice Address - Street 1:101 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-3123
Practice Address - Country:US
Practice Address - Phone:201-525-8926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4609235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist