Healthcare Provider Details

I. General information

NPI: 1346655537
Provider Name (Legal Business Name): RACHEL REDMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 LAURENCE AVE SUITE B
JACKSON MI
49202-2979
US

IV. Provider business mailing address

1001 LAURENCE AVE SUITE B
JACKSON MI
49202-2979
US

V. Phone/Fax

Practice location:
  • Phone: 517-750-4777
  • Fax: 517-782-4777
Mailing address:
  • Phone: 517-750-4777
  • Fax: 517-782-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: