Healthcare Provider Details

I. General information

NPI: 1871738435
Provider Name (Legal Business Name): RACHEL T KELLEY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL DIETSCHE

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 10TH ST STE 200
SANTA ROSA CA
95401-5291
US

IV. Provider business mailing address

2227 CAPRICORN WAY STE 207208
SANTA ROSA CA
95407-5478
US

V. Phone/Fax

Practice location:
  • Phone: 707-579-0465
  • Fax:
Mailing address:
  • Phone: 707-978-8607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number94028198
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: