Provider Demographics
NPI:1871729053
Name:O'CONNELL, RACHEL CHRISTINE (SLP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:CHRISTINE
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:CHRISTINE
Other - Last Name:RUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 LIND AVE SW
Mailing Address - Street 2:STE 100 ATTN CREDENTIALING
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057
Mailing Address - Country:US
Mailing Address - Phone:425-690-2715
Mailing Address - Fax:
Practice Address - Street 1:3600 LIND AVE SW
Practice Address - Street 2:STE 160
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4934
Practice Address - Country:US
Practice Address - Phone:425-690-3513
Practice Address - Fax:425-690-9513
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60032969235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2037887Medicaid