Provider Demographics
NPI:1063996338
Name:HEDRICK, RACHEL LAUREN (PSYD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LAUREN
Last Name:HEDRICK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 BROADWAY
Mailing Address - Street 2:SUITE 518
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209
Mailing Address - Country:US
Mailing Address - Phone:210-858-1900
Mailing Address - Fax:210-745-4525
Practice Address - Street 1:1314 E SONTERRA BLVD
Practice Address - Street 2:SUITE 2208
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-858-1900
Practice Address - Fax:210-745-4525
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37086103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist