Provider Demographics
NPI:1902216997
Name:JADKOWSKI, RACHEL E (PSYD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:E
Last Name:JADKOWSKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1158
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VT
Mailing Address - Zip Code:05477-1158
Mailing Address - Country:US
Mailing Address - Phone:503-476-2528
Mailing Address - Fax:
Practice Address - Street 1:117A W MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VT
Practice Address - Zip Code:05477-4451
Practice Address - Country:US
Practice Address - Phone:503-476-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048.0100344103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical