Provider Demographics
NPI:1336504158
Name:BLOUGH, RACHEL SUE
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:SUE
Last Name:BLOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 KIMBALL AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5757
Mailing Address - Country:US
Mailing Address - Phone:319-214-9055
Mailing Address - Fax:319-233-1751
Practice Address - Street 1:3641 KIMBALL AVE STE 203
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5757
Practice Address - Country:US
Practice Address - Phone:319-214-9055
Practice Address - Fax:319-233-1751
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001690101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health