Individual
ELIZA RACHELLE GEDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D., LP
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
12966150-25801
UT
103TC1900X
Counseling Psychologist
6301014858
MI
1041C0700X
Clinical Social Worker
12966150-2501
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1883825
—
MI
Enumeration date
09/08/2011
Last updated
04/02/2024
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