Provider Demographics
NPI:1639687916
Name:DEAN, RACHAEL RENEE (DTV)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:RENEE
Last Name:DEAN
Suffix:
Gender:F
Credentials:DTV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1943 BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-6041
Mailing Address - Country:US
Mailing Address - Phone:217-371-9337
Mailing Address - Fax:
Practice Address - Street 1:1943 BALDWIN RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-6041
Practice Address - Country:US
Practice Address - Phone:217-371-9337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-20
Last Update Date:2018-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency