Provider Demographics
NPI:1518765569
Name:WENTZ, RACHEL NICHOLE
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:NICHOLE
Last Name:WENTZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 MICOSUKE CMNS DR APT 1317
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5440
Mailing Address - Country:US
Mailing Address - Phone:727-580-5850
Mailing Address - Fax:
Practice Address - Street 1:2937 KERRY FOREST PKWY STE B1
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-7800
Practice Address - Country:US
Practice Address - Phone:850-890-4852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI73522355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant