1841512829 NPI number — MRS. RACHAEL MARY MCKINNON LMSW

Table of content: MRS. RACHAEL MARY MCKINNON LMSW (NPI 1841512829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841512829 NPI number — MRS. RACHAEL MARY MCKINNON LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKINNON
Provider First Name:
RACHAEL
Provider Middle Name:
MARY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLARK
Provider Other First Name:
RACHAEL
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841512829
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
690 SOUTH TRUMBULL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-922-4900
Provider Business Mailing Address Fax Number:
989-922-4911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
690 SOUTH TRUMBULL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAY CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-922-4900
Provider Business Practice Location Address Fax Number:
989-922-4911
Provider Enumeration Date:
02/18/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6801091574 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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