Raechal Lynn Wallak, M.S. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

030181 Issued in NY

Practice address

150 Stahl Road
Getzville, NY 14068-1231

Phone

(716) 629-3400

NPI assigned

Mar 11, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Raechal Lynn Mack Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1552262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667347200000",
    "number": "1316405129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 BIRCH DRIVE",
            "city": "NORTH TONAWANDA",
            "state": "NY",
            "postal_code": "14120",
            "telephone_number": "716-812-5750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 STAHL ROAD",
            "city": "GETZVILLE",
            "state": "NY",
            "postal_code": "140681231",
            "telephone_number": "716-629-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLAK",
        "first_name": "RAECHAL",
        "middle_name": "LYNN",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-11",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "030181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06511893",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RAECHAL",
            "last_name": "MACK",
            "middle_name": "LYNN",
            "credential": "M.S. CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Dina Velia Vorreuter, RPH
• Christy Wach, M.S. ED.
• Lucy Barrell Wagle, M.A.
• Michelle Constance Walker, M.A., C.A.S.
• Rachel Joy Wallace
• William Walsh II
• Elizabeth Walters, M.S., SLP
• Emily Brooks Warren, MSW
• Taylor Weber, M.A.
• Mary J Whipple, RN

• Speech-Language Pathologist in Getzville, NY
• Providers in Getzville, NY by specialty
• Speech-Language Pathologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.