Organization
RACHEL MICKELSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RACHEL LYNN MICKELSON PSYD, HSPP (CLINICAL PSYCHOLOGIST)
(574) 243-9370
Entity
Organization
Contact information
Practice address
2106 IRONWOOD CIR, SOUTH BEND, IN 46635-1864
(574) 243-9370
Mailing address
2106 IRONWOOD CIR, SOUTH BEND, IN 46635-1864
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20042493A
IN
Other
Enumeration date
07/17/2012
Last updated
07/17/2012
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