Healthcare Provider Details

I. General information

NPI: 1679401236
Provider Name (Legal Business Name): RACHEL SANTIAGO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 HILL HALL
COLUMBIA MO
65211-2130
US

IV. Provider business mailing address

PO BOX 30624
COLUMBIA MO
65205-3624
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-0199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2024044401
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: