Provider Demographics
NPI:1558648774
Name:BRITTON, RACHAEL (MA)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:BRITTON
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 1:4660 SLATER RD STE 145
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-4047
Mailing Address - Country:US
Mailing Address - Phone:651-440-9159
Mailing Address - Fax:
Practice Address - Street 1:7300 W 147TH STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124
Practice Address - Country:US
Practice Address - Phone:952-997-3020
Practice Address - Fax:952-997-3026
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5975103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program