Provider Demographics
NPI:1578351425
Name:BLACKWOOD-PEREZ, RACHEL LYN
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYN
Last Name:BLACKWOOD-PEREZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 JEV CT NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-2652
Mailing Address - Country:US
Mailing Address - Phone:541-270-1952
Mailing Address - Fax:
Practice Address - Street 1:2405 FRONT ST NE STE 230
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0860
Practice Address - Country:US
Practice Address - Phone:541-270-1952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA13531104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker