Provider Demographics
NPI:1386985430
Name:RAJCICH, REBECCA A (RD, CD)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:A
Last Name:RAJCICH
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5923 178TH PL SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3521
Mailing Address - Country:US
Mailing Address - Phone:425-280-6476
Mailing Address - Fax:
Practice Address - Street 1:1904 3RD AVE STE 918
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3325
Practice Address - Country:US
Practice Address - Phone:206-595-0976
Practice Address - Fax:206-347-6053
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 60193092133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered