Provider Demographics
NPI:1285865998
Name:ROLDAN, RACHAEL HERRINGTON (PHD)
Entity type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:HERRINGTON
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 S NATIONAL AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2213
Mailing Address - Country:US
Mailing Address - Phone:417-413-1724
Mailing Address - Fax:
Practice Address - Street 1:1911 S NATIONAL AVE STE 401
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2213
Practice Address - Country:US
Practice Address - Phone:417-413-1724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009019261103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000000771573OtherANTHEM BLUECROSS BLUESHIELD