Provider Demographics
NPI:1013970250
Name:ALLYN, RACHEL JANE (PHD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:JANE
Last Name:ALLYN
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 1:4200 MINNETONKA BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5191
Mailing Address - Country:US
Mailing Address - Phone:801-661-3524
Mailing Address - Fax:
Practice Address - Street 1:4200 MINNETONKA BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-5191
Practice Address - Country:US
Practice Address - Phone:801-661-3524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT60174772504103TC0700X
MN5171103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical