Provider Demographics
NPI:1780086496
Name:MINELLI, RACHEL (PHD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MINELLI
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 1:7020 FAIRBANKS ST
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7076
Mailing Address - Country:US
Mailing Address - Phone:618-806-3234
Mailing Address - Fax:
Practice Address - Street 1:145 SPRINGFIELD CT
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2495
Practice Address - Country:US
Practice Address - Phone:217-525-8332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008754103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical