Provider Demographics
NPI:1336360643
Name:RODNEY, RACHEL (MS,RD,CSSD,CDE)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:RODNEY
Suffix:
Gender:F
Credentials:MS,RD,CSSD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CONIFER LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05363-7946
Mailing Address - Country:US
Mailing Address - Phone:860-550-0359
Mailing Address - Fax:
Practice Address - Street 1:508 MAIN ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2111
Practice Address - Country:US
Practice Address - Phone:860-550-0359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT074-0000201133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1016946Medicaid
VT1016946Medicaid