Provider Demographics
NPI:1699489138
Name:WILGENHOF, RACHEL (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:WILGENHOF
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-0220
Mailing Address - Country:US
Mailing Address - Phone:304-203-2508
Mailing Address - Fax:
Practice Address - Street 1:340 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-2922
Practice Address - Country:US
Practice Address - Phone:304-203-2508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2365235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2365OtherSLP LICENSE