Provider Demographics
NPI:1982451985
Name:RAUCH, ALEXANDRA LEIGH (MS, LPC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LEIGH
Last Name:RAUCH
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:LEIGH
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1260 DERRY LN
Mailing Address - Street 2:
Mailing Address - City:PINGREE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-9122
Mailing Address - Country:US
Mailing Address - Phone:224-622-6499
Mailing Address - Fax:
Practice Address - Street 1:1590 S MILWAUKEE AVE STE 211
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3785
Practice Address - Country:US
Practice Address - Phone:224-622-6499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017474101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional