Provider Demographics
NPI:1164931887
Name:MEREDITH, RACHEL LEAH (MSED)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LEAH
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9240 GROSS POINT RD APT 406
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1370
Mailing Address - Country:US
Mailing Address - Phone:574-229-4056
Mailing Address - Fax:
Practice Address - Street 1:9240 GROSS POINT RD APT 406
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1370
Practice Address - Country:US
Practice Address - Phone:574-229-4056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
174400000X
NY12153993103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No174400000XOther Service ProvidersSpecialist