Healthcare Provider Details

I. General information

NPI: 1710668355
Provider Name (Legal Business Name): RACHEL MADISON CRANDALL RDN, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 S YELLOWSTONE HWY STE 2201
REXBURG ID
83440-5595
US

IV. Provider business mailing address

5635 PETERS WAY
IDAHO FALLS ID
83404-8062
US

V. Phone/Fax

Practice location:
  • Phone: 208-649-8300
  • Fax: 208-684-2863
Mailing address:
  • Phone: 208-716-8124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD-1518
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1381112
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: