MEDICARE: RACHEL J RIDGE LCSW MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149012691	IL

General Provider Information

NPI Number	:	1255305330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL J RIDGE LCSW MS

Provider Business Mailing Address
First Line	:	11885 ELISE BLVD
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-7989
Country	:	US
Telephone Number	:	708-269-1516
Fax Number	:

Provider Business Practice Location Address
First Line	:	10217 W LINCOLN HWY
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-1279
Country	:	US
Telephone Number	:	815-806-7560
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	06/05/2023

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