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General NPI Number Information
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NPI Number | 1710668355
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Entity Type | Individual
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Provider Name | RACHEL MADISON CRANDALL RDN, LPC
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Gender | Female
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Dates
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Enumeration Date | 07/27/2023
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | 859 S YELLOWSTONE HWY STE 2201
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City | REXBURG
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State | ID
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Zip | 83440-5595
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Country | US
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Telephone | 208-649-8300
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Fax | 208-684-2863
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Provider Business Mailing Address
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Address Line | 5635 PETERS WAY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-8062
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Country | US
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Telephone | 208-716-8124
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | D-1518
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1381112
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License Number State | ID
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