Basic Information
Provider Information
NPI: 1508992363
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANDREWS
FirstName: RACHEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3587 HEATHROW WAY
Address2:  
City: MEDFORD
State: OR
PostalCode: 975044004
CountryCode: US
TelephoneNumber: 5418588170
FaxNumber:  
Practice Location
Address1: 1245 BIRCH AVE
Address2:  
City: COTTAGE GROVE
State: OR
PostalCode: 974241413
CountryCode: US
TelephoneNumber: 5417674190
FaxNumber: 5419426810
Other Information
ProviderEnumerationDate: 02/26/2007
LastUpdateDate: 03/08/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XL7546ORY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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