National Provider Identifier
Raechal Lynn Wallak, M.S.CCC-SLP
Raechal Lynn Wallak, M.S.CCC-SLP is listed in the NPPES registry with a primary specialty of Speech-Language Pathologist in Getzville, NY and a listed phone number of (716) 629-3400.
Profile Overview
- NPI
- 1316405129
- Provider Type
- Individual
- Primary Specialty
- Speech-Language Pathologist
- Enumeration Date
- March 11, 2019
- Last Updated
- November 02, 2022
Practice Location
- 150 Stahl Road
- Getzville, NY 14068-1231
Phone: (716) 629-3400
Mailing Address
- 1400 Birch Drive
- North Tonawanda, NY 14120
Specialties
- Speech-Language Pathologist (235Z00000X)
- Speech-Language Pathologist (235Z00000X)
Full Record
- NPI
- 1316405129
- Entity Type
- Individual
- Last Name
- Wallak
- First Name
- Raechal
- Middle Name
- Lynn
- Credential
- M.S.CCC-SLP
- Provider Other Last Name
- Mack
- Provider Other First Name
- Raechal
- Provider Other Middle Name
- Lynn
- Provider Other Credential Text
- M.S.CCC-SLP
- Provider Other Last Name Type Code
- 1
- Mailing Street Address
- 1400 Birch Drive
- Mailing City
- North Tonawanda
- Mailing State
- NY
- Mailing ZIP Code
- 14120
- Mailing Country
- US
- Mailing Phone
- (716) 812-5750
- Practice Street Address
- 150 Stahl Road
- Practice City
- Getzville
- Practice State
- NY
- Practice ZIP Code
- 14068-1231
- Practice Country
- US
- Practice Phone
- (716) 629-3400
- Enumeration Date
- March 11, 2019
- Last Updated
- November 02, 2022
- Sex
- Female
- Sole Proprietor
- No
- Certification Date
- November 02, 2022
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Speech-Language Pathologist (235Z00000X), Speech-Language Pathologist (235Z00000X)
- Other Identifiers
- 06511893 (NY)