Provider Demographics
NPI:1225848179
Name:MILES, RACHEL (EDS)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6065 W A ST
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-3045
Mailing Address - Country:US
Mailing Address - Phone:503-825-7634
Mailing Address - Fax:
Practice Address - Street 1:6065 W A ST
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-3045
Practice Address - Country:US
Practice Address - Phone:503-825-7634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA522236R103TS0200X
OR502256103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool