Provider Demographics
NPI:1528617941
Name:RASCHIATORE, JENNA (SLP)
Entity type:Individual
Prefix:MS
First Name:JENNA
Middle Name:
Last Name:RASCHIATORE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 BOUNDARY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21661-1604
Mailing Address - Country:US
Mailing Address - Phone:410-778-6422
Mailing Address - Fax:
Practice Address - Street 1:114 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:MD
Practice Address - Zip Code:21635-1525
Practice Address - Country:US
Practice Address - Phone:410-810-2510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01980L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist