Provider Demographics
NPI:1861421109
Name:WHITE, RACHEL CONDON
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:CONDON
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:KRISTINE
Other - Last Name:CONDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1120 E ELIZABETH ST
Mailing Address - Street 2:F-101
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4044
Mailing Address - Country:US
Mailing Address - Phone:970-221-1177
Mailing Address - Fax:970-484-5990
Practice Address - Street 1:1120 E ELIZABETH ST
Practice Address - Street 2:F-101
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4044
Practice Address - Country:US
Practice Address - Phone:970-221-1177
Practice Address - Fax:970-484-5990
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO358231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist