Provider Demographics
NPI:1386391712
Name:KNUDSON, RACHEL E (LAC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:E
Last Name:KNUDSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:E
Other - Last Name:LYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7354 W GREER AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-1101
Mailing Address - Country:US
Mailing Address - Phone:928-792-6313
Mailing Address - Fax:
Practice Address - Street 1:7354 W GREER AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-1101
Practice Address - Country:US
Practice Address - Phone:928-792-6313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-06
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health