Provider Demographics
NPI:1316166838
Name:RACCUIA, JACQUELINE (SLP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:RACCUIA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3143 ROUTE 9G
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-3516
Mailing Address - Country:US
Mailing Address - Phone:732-995-4865
Mailing Address - Fax:
Practice Address - Street 1:70 OVEROCKER RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2035
Practice Address - Country:US
Practice Address - Phone:845-485-9803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00265600235Z00000X
NY014035-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist