Provider Demographics
NPI:1013138510
Name:RAUSCHENBACH, JOE
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:RAUSCHENBACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 E HEIDI LOOP
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1845
Mailing Address - Country:US
Mailing Address - Phone:928-526-9314
Mailing Address - Fax:
Practice Address - Street 1:7150 SILVER SADDLE RD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-3207
Practice Address - Country:US
Practice Address - Phone:928-527-3873
Practice Address - Fax:928-526-8985
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool