Provider Demographics
NPI:1912236431
Name:KEILSON FLEISCHMANN, RACHELL S
Entity type:Individual
Prefix:MRS
First Name:RACHELL
Middle Name:S
Last Name:KEILSON FLEISCHMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHELL
Other - Middle Name:
Other - Last Name:KEILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:533 HICKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5423
Mailing Address - Country:US
Mailing Address - Phone:718-471-0077
Mailing Address - Fax:
Practice Address - Street 1:533 HICKSVILLE RD
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5423
Practice Address - Country:US
Practice Address - Phone:718-471-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019589235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist