Provider Demographics
NPI:1770069486
Name:SCHMIDLI, RACHEL LEEANN (BCBA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LEEANN
Last Name:SCHMIDLI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LEEANN
Other - Last Name:BIRK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:2620 FORUM BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5454
Mailing Address - Country:US
Mailing Address - Phone:573-514-8735
Mailing Address - Fax:
Practice Address - Street 1:205 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6521
Practice Address - Country:US
Practice Address - Phone:573-884-6052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1-20-43239103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst