Provider Demographics
NPI:1538688460
Name:CRAIG, RACHEL DANAE (AUD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:DANAE
Last Name:CRAIG
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10607 TESCH LN APT 9
Mailing Address - Street 2:
Mailing Address - City:ROTHSCHILD
Mailing Address - State:WI
Mailing Address - Zip Code:54474-9000
Mailing Address - Country:US
Mailing Address - Phone:715-803-5285
Mailing Address - Fax:
Practice Address - Street 1:1901 4TH AVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1909
Practice Address - Country:US
Practice Address - Phone:715-346-3667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI649-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391805963Medicaid