Provider Demographics
NPI:1255409926
Name:KORDZIKOWSKI, RACHAEL REY
Entity type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:REY
Last Name:KORDZIKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7200 SKYWAY
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-3280
Mailing Address - Country:US
Mailing Address - Phone:530-877-1965
Mailing Address - Fax:530-894-5791
Practice Address - Street 1:7200 SKYWAY
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-3280
Practice Address - Country:US
Practice Address - Phone:530-877-1965
Practice Address - Fax:530-894-5791
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT79998106H00000X
CA60802106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist