Provider Demographics
NPI:1619384138
Name:AXTELLE, RACHEL REESE (MA)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:REESE
Last Name:AXTELLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9643 SE CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-8902
Mailing Address - Country:US
Mailing Address - Phone:360-850-7342
Mailing Address - Fax:
Practice Address - Street 1:9643 SE CAMBRIDGE RD
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-8902
Practice Address - Country:US
Practice Address - Phone:360-850-7342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst