Healthcare Provider Details

I. General information

NPI: 1588421655
Provider Name (Legal Business Name): RACHEL BIDDINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1272 LONGFELLOW AVE
SOUTH BEND IN
46615-1120
US

IV. Provider business mailing address

1272 LONGFELLOW AVE
SOUTH BEND IN
46615-1120
US

V. Phone/Fax

Practice location:
  • Phone: 443-547-0519
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2849062
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: