Provider Demographics
NPI:1144522889
Name:RIDGEWAY, RACHELLE ERIN (MS ED)
Entity type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:ERIN
Last Name:RIDGEWAY
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-3309
Mailing Address - Country:US
Mailing Address - Phone:618-457-6703
Mailing Address - Fax:
Practice Address - Street 1:604 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-3309
Practice Address - Country:US
Practice Address - Phone:618-457-6703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health