1205492014 NPI number — RACHEL ANNE HEMPERLY BODMAN MA, LMHC

Table of content: RACHEL ANNE HEMPERLY BODMAN MA, LMHC (NPI 1205492014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205492014 NPI number — RACHEL ANNE HEMPERLY BODMAN MA, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BODMAN
Provider First Name:
RACHEL
Provider Middle Name:
ANNE HEMPERLY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HEMPERLY
Provider Other First Name:
RACHEL
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LMHC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1205492014
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2027 196TH ST SW STE A205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNNWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98036-7073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-224-5740
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16825 48TH AVE W STE 346
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98037-6408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-224-5740
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MC60899855 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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