Provider Demographics
NPI:1669887212
Name:CONDON, RACHAEL ANGELINE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:ANGELINE
Last Name:CONDON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:RACHAEL
Other - Middle Name:ANGELINE
Other - Last Name:MIERZWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1370 ANDERS RD
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-4846
Mailing Address - Country:US
Mailing Address - Phone:201-787-7863
Mailing Address - Fax:
Practice Address - Street 1:1370 ANDERS RD
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-4846
Practice Address - Country:US
Practice Address - Phone:201-787-7863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011980235Z00000X
NJ41YS00798600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist