Provider Demographics
NPI:1831686971
Name:RAYNIAK, RACHEL ANN (BA)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ANN
Last Name:RAYNIAK
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5988 LONGFORD RD
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-2943
Mailing Address - Country:US
Mailing Address - Phone:907-903-1894
Mailing Address - Fax:
Practice Address - Street 1:1750 COMMERCE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-6333
Practice Address - Country:US
Practice Address - Phone:937-878-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-14
Last Update Date:2018-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician