Healthcare Provider Details

I. General information

NPI: 1073300414
Provider Name (Legal Business Name): RACHEL WAKEFIELD PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL WHITMAN

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 NW 9TH ST STE 320
CORVALLIS OR
97330-6169
US

IV. Provider business mailing address

PO BOX 1189
CORVALLIS OR
97339-1189
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-1840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number4067
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: