Provider Demographics
NPI:1427460823
Name:RACHELLE, JORDENNE (MA)
Entity type:Individual
Prefix:
First Name:JORDENNE
Middle Name:
Last Name:RACHELLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95006-8910
Mailing Address - Country:US
Mailing Address - Phone:408-829-7961
Mailing Address - Fax:
Practice Address - Street 1:133 GROVE ST
Practice Address - Street 2:
Practice Address - City:BOULDER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95006-8910
Practice Address - Country:US
Practice Address - Phone:408-829-7961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health