Provider Demographics
NPI:1003883471
Name:DAVIS, RACHEL JUDITH (PSYD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:JUDITH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:DAVIS
Other - Last Name:KOHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2160 S FIRST AVE
Mailing Address - Street 2:LOYOLA UNIVERSITY MEDICAL CENTER 101-1740
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-9000
Mailing Address - Fax:708-216-9033
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:LOYOLA UNIVERSITY MEDICAL CENTER 101-1740
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-9000
Practice Address - Fax:708-216-9033
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL71006245Medicaid
P37103Medicare UPIN
IL205768Medicare ID - Type Unspecified
IL902350Medicare ID - Type Unspecified