Provider Demographics
NPI:1831817808
Name:IACANO, RACHEL (EDS)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:IACANO
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 W 3RD AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3290
Mailing Address - Country:US
Mailing Address - Phone:234-542-7232
Mailing Address - Fax:
Practice Address - Street 1:2140 ATLAS ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-9647
Practice Address - Country:US
Practice Address - Phone:614-921-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH22473201103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool