Provider Demographics
NPI:1881168912
Name:DICK, RACHEL (BCBA, MA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:DICK
Suffix:
Gender:F
Credentials:BCBA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 E 83RD AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6307
Mailing Address - Country:US
Mailing Address - Phone:219-472-0628
Mailing Address - Fax:219-750-9287
Practice Address - Street 1:1477 E 83RD AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6307
Practice Address - Country:US
Practice Address - Phone:219-472-0628
Practice Address - Fax:219-750-9287
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-18-34333OtherBEHAVIOR ANALYST CERTIFICATION BOARD