Provider Demographics
NPI:1811255235
Name:BLAYLOCK, RACHEL MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:BLAYLOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:MARIE
Other - Last Name:WOODRUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1255 N 1200 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2445
Mailing Address - Country:US
Mailing Address - Phone:801-229-1181
Mailing Address - Fax:
Practice Address - Street 1:1255 N 1200 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2445
Practice Address - Country:US
Practice Address - Phone:801-229-1181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical