Provider Demographics
NPI:1427478536
Name:JORDAAN, RACHEL M
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:M
Last Name:JORDAAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:M
Other - Last Name:CARSRUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARRINGTON
Mailing Address - State:ND
Mailing Address - Zip Code:58421-1729
Mailing Address - Country:US
Mailing Address - Phone:701-652-3117
Mailing Address - Fax:701-652-3118
Practice Address - Street 1:50 POPLAR AVE S
Practice Address - Street 2:
Practice Address - City:CARRINGTON
Practice Address - State:ND
Practice Address - Zip Code:58421-2266
Practice Address - Country:US
Practice Address - Phone:701-652-3117
Practice Address - Fax:701-652-3118
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND56718Medicaid