Provider Demographics
NPI:1902902471
Name:DESCOMBAZ, RAECHEL M (MS, CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:RAECHEL
Middle Name:M
Last Name:DESCOMBAZ
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 1:1879 PORTLAND AVE
Mailing Address - Street 2:#2
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5956
Mailing Address - Country:US
Mailing Address - Phone:612-388-1235
Mailing Address - Fax:
Practice Address - Street 1:1879 PORTLAND AVE
Practice Address - Street 2:#2
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5956
Practice Address - Country:US
Practice Address - Phone:612-388-1235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist