Provider Demographics
NPI:1952067233
Name:KORNACKER, RACHEL ANNE (PSYD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANNE
Last Name:KORNACKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:HELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2215 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1265
Mailing Address - Country:US
Mailing Address - Phone:224-268-0026
Mailing Address - Fax:
Practice Address - Street 1:2215 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1265
Practice Address - Country:US
Practice Address - Phone:224-268-0026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071010634103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist