Provider Demographics
NPI:1154154284
Name:ROUSSIN, RACHEL YVONNE
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:YVONNE
Last Name:ROUSSIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 STONEY MEADOWS DR APT A
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63088-1246
Mailing Address - Country:US
Mailing Address - Phone:314-809-2966
Mailing Address - Fax:
Practice Address - Street 1:2644 METRO BLVD
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-2412
Practice Address - Country:US
Practice Address - Phone:314-395-9375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024011631103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst