Provider Demographics
NPI:1235858341
Name:SYDNER, RACHAEL (LAC)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:SYDNER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:SYDNER
Other - Middle Name:
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:130 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-2206
Mailing Address - Country:US
Mailing Address - Phone:316-283-6743
Mailing Address - Fax:
Practice Address - Street 1:6711 STATE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-3020
Practice Address - Country:US
Practice Address - Phone:913-359-6111
Practice Address - Fax:913-730-7604
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01799101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health