MEDICARE: SOPHIA JEAN RACHWAL

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1376235002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA JEAN RACHWAL

Provider Business Mailing Address
First Line	:	7537 20TH AVE STE 105
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-7702
Country	:	US
Telephone Number	:	616-209-8280
Fax Number	:

Provider Business Practice Location Address
First Line	:	1915 GEORGETOWN CENTER DR STE 101
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-7121
Country	:	US
Telephone Number	:	616-209-8280
Fax Number	:

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

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	02/19/2026

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