Provider Demographics
NPI:1316313299
Name:RAWLINS, AUDREY (CCC-SLP MA)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:RAWLINS
Suffix:
Gender:F
Credentials:CCC-SLP MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3053 TWIN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62707-9312
Mailing Address - Country:US
Mailing Address - Phone:217-899-9421
Mailing Address - Fax:
Practice Address - Street 1:2035 W ILES AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-4192
Practice Address - Country:US
Practice Address - Phone:217-679-5080
Practice Address - Fax:217-679-5386
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009972235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist