Active NPI
Rachel Sue Blough
- Mental Health Counselor
- Waterloo, IA
National Provider Identifier
1336504158
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 001690
- Practice address
- 3641 Kimball Ave Ste 203
Waterloo, IA 50702-5757 - Phone
- (319) 214-9055
- Fax
- (319) 233-1751
- NPI assigned
- Dec 21, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 001690 | IA | Primary |
Addresses
Primary practice location
3641 Kimball Ave Ste 203
Waterloo, IA 50702-5757
Mailing address
3641 Kimball Ave Ste 203
Waterloo, IA 50702-5757
Phone (319) 214-9055
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001690 | IA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1450656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651708800000",
"number": "1336504158",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3641 KIMBALL AVE STE 203",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507025757",
"telephone_number": "319-214-9055",
"fax_number": "319-233-1751"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3641 KIMBALL AVE STE 203",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507025757",
"telephone_number": "319-214-9055",
"fax_number": "319-233-1751"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOUGH",
"first_name": "RACHEL",
"middle_name": "SUE",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-12-21",
"last_updated": "2022-05-05",
"certification_date": "2022-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IA",
"license": "001690",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterloo, IA
- Black Hawk Nursing and Rehabilitation, LLC
- Black Hawk Nursing and Rehabilitation, LLC
- Black Hawk-Grundy Mental Health Center Inc.
- Natalie Ann Bloom, ARNP, FNP-C
- Michael J Blough, DC
- Wayde Russell Blumhardt, CRNA
- Kathryn Marie Boaldin, DPT
- Bryan Boardsen, MOT
- Ann Marie Bock, MSN,ARNP, FNP-C
- Zubair Hassan Bodla, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.