Rachael Herrington Roldan, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2009019261 Issued in MO

Practice address

1911 S National Ave Ste 401
Springfield, MO 65804-2213

Phone

(417) 413-1724

NPI assigned

Jul 29, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2025 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• 417 Psych, LLC

  • Clinical Psychologist
  • Springfield, MO
  • NPI 1699653022
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1248825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1285865998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1911 S NATIONAL AVE STE 401",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042213",
            "telephone_number": "417-413-1724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1911 S NATIONAL AVE STE 401",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042213",
            "telephone_number": "417-413-1724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROLDAN",
        "first_name": "RACHAEL",
        "middle_name": "HERRINGTON",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-29",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MO",
            "license": "2009019261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Andrew Rogers, LPC
• Molly Rohall
• Ami Rohr, FNP
• Stacy Loc Rohrbaugh, NP-C
• Candace Chantel Roland, FNP
• Clara Jane Rollins
• Roma J Turner DC LLC
• Crystal Romay, R.N.
• Frank Romero Jr., M.D.
• Angela Romine, MASSAGE THERAPIST

• Psychologist in Springfield, MO
• Providers in Springfield, MO by specialty
• Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.