Provider Demographics
NPI:1528142155
Name:RAICA, ANTHONY NICHOLAS (MS CCCA)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:NICHOLAS
Last Name:RAICA
Suffix:
Gender:M
Credentials:MS CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 W DAVIS STREET
Mailing Address - Street 2:SUITE E
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-1872
Mailing Address - Country:US
Mailing Address - Phone:936-788-2212
Mailing Address - Fax:936-788-2231
Practice Address - Street 1:3301 W DAVIS STREET
Practice Address - Street 2:SUITE E
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1872
Practice Address - Country:US
Practice Address - Phone:936-788-2212
Practice Address - Fax:936-788-2231
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50232231H00000X
TX90230237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX50232OtherSTATE BOARD EXAMINERS FOR
TX90230OtherSTATE BOARD EXAMINERS TO