1609444512 NPI number — MRS. RACHEL LEANNE MITCHELL BASW

Table of content: MRS. RACHEL LEANNE MITCHELL BASW (NPI 1609444512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609444512 NPI number — MRS. RACHEL LEANNE MITCHELL BASW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
RACHEL
Provider Middle Name:
LEANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BASW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WYBORNY
Provider Other First Name:
RACHEL
Provider Other Middle Name:
LEANNE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
BASW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609444512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11172 ADAMS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49423-9163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11172 ADAMS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49423-9163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-942-2522
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2021

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: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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