Provider Demographics
NPI:1427663533
Name:LIBENGOOD, RACHEL DAWN
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:DAWN
Last Name:LIBENGOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:DAWN
Other - Last Name:LEDGERWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1801 AMERICAN BLVD E STE 8
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1230
Mailing Address - Country:US
Mailing Address - Phone:612-331-9413
Mailing Address - Fax:
Practice Address - Street 1:1801 AMERICAN BLVD E STE 8
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1230
Practice Address - Country:US
Practice Address - Phone:612-331-9413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician