Active NPI
Rachel Esther Theofanis, CCC-SLP
- Speech-Language Pathologist
- Milwaukee, WI
National Provider Identifier
1972979698
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP-3111
- Practice address
- 833 N. 26TH Street
Milwaukee, WI 53233 - Phone
- (414) 344-7676
- NPI assigned
- Aug 17, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP-3111 | ID | Primary |
Addresses
Primary practice location
833 N. 26TH Street
Milwaukee, WI 53233
Mailing address
833 N 26TH St
Milwaukee, WI 53233-1507
Phone (414) 344-7676
Other practice location 1
4500 E Cherry Creek South Dr Ste 710
Denver, CO 80246-1534
Phone (303) 432-8487
Other practice location 2
415 W 2nd N
Mountain Home, ID 83647-2548
Phone (208) 587-2595
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP-3111 | ID | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Penfield Children'S Center, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinic/Center
- Milwaukee, WI
- NPI 1275692410
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651449600000",
"number": "1972979698",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "833 N 26TH ST",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532331507",
"telephone_number": "414-344-7676"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "833 N. 26TH STREET",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "53233",
"telephone_number": "414-344-7676"
}
],
"practiceLocations": [
{
"address_1": "4500 E Cherry Creek South Dr Ste 710",
"address_purpose": "LOCATION",
"city": "Denver",
"state": "CO",
"postal_code": "802461534",
"country_code": "US",
"telephone_number": "303-432-8487",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "415 W 2nd N",
"address_purpose": "LOCATION",
"city": "Mountain Home",
"state": "ID",
"postal_code": "836472548",
"country_code": "US",
"telephone_number": "208-587-2595",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "THEOFANIS",
"first_name": "RACHEL",
"middle_name": "ESTHER",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-17",
"last_updated": "2022-05-02",
"certification_date": "2022-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "ID",
"license": "SLP-3111",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 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.