Provider Demographics
NPI:1871738435
Name:DIETSCHE, RACHEL T (MS)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:T
Last Name:DIETSCHE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 CAPRICORN WAY STE 207208
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-5478
Mailing Address - Country:US
Mailing Address - Phone:707-978-8607
Mailing Address - Fax:
Practice Address - Street 1:2227 CAPRICORN WAY STE 207208
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5478
Practice Address - Country:US
Practice Address - Phone:707-978-8607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178005889101YP2500X
171M00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1871738435Medicaid