Healthcare Provider Details

I. General information

NPI: 1689548901
Provider Name (Legal Business Name): RACHAEL MARIE JENSEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHAEL MARIE RYDALCH LMSW

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 MADISON PROFESSIONAL PARK
REXBURG ID
83440-2057
US

IV. Provider business mailing address

33 MADISON PROFESSIONAL PARK
REXBURG ID
83440-2057
US

V. Phone/Fax

Practice location:
  • Phone: 208-243-9304
  • Fax: 208-656-5668
Mailing address:
  • Phone: 208-243-9304
  • Fax: 208-656-5668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8971179
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: