Doctor Name: | NANCY SANSOM RATHBURN |
NPI Number: | 1104126895 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MACCC-SLP |
License Number: | 22001327A |
Business Practice Address: | 3320 E State Blvd Fort Wayne, IN - 468055601 |
Business Phone Number: | 2604843120 |
Business Fax Number: | 2609690104 |
Mailing Address: | 3320 E State Blvd, FORT WAYNE |
State: | IN |
Postal Code: | 468055601 |
Phone Number: | 2604843120 |
Fax Number: | 2609690104 |
NPI Enumeration Date: | 10/27/2010 |
NPI Last Update Date: | 10/27/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 22001327A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |