Provider Demographics
NPI:1659417673
Name:RAUSCH, DEIDRA TAYLOR (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEIDRA
Middle Name:TAYLOR
Last Name:RAUSCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 W 116TH ST
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-9311
Mailing Address - Country:US
Mailing Address - Phone:317-873-8140
Mailing Address - Fax:317-873-8141
Practice Address - Street 1:4715 W 116TH ST
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-9311
Practice Address - Country:US
Practice Address - Phone:317-873-8140
Practice Address - Fax:317-873-8141
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001402A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist