Provider Demographics
NPI:1114018801
Name:DEGRAAF, REBECCA VANTIL (PHD)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:VANTIL
Last Name:DEGRAAF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 FORUM BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203
Mailing Address - Country:US
Mailing Address - Phone:573-446-5034
Mailing Address - Fax:573-446-5046
Practice Address - Street 1:2804 FORUM BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203
Practice Address - Country:US
Practice Address - Phone:573-446-5034
Practice Address - Fax:573-446-5046
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0528103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist