Provider Demographics
NPI:1962077941
Name:SIMPSON, RACQUEL J (MS, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:MS
First Name:RACQUEL
Middle Name:J
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N CLARA AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-4207
Mailing Address - Country:US
Mailing Address - Phone:386-734-7190
Mailing Address - Fax:
Practice Address - Street 1:200 N CLARA AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-4207
Practice Address - Country:US
Practice Address - Phone:386-734-7190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-23
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist