Healthcare Provider Details

I. General information

NPI: 1972793123
Provider Name (Legal Business Name): RACHEL SWANSON RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E MAIN ST
CLINTON CT
06413-2112
US

IV. Provider business mailing address

635 MAIN ST ATTN: CREDENTIALING DEPARTMENT
MIDDLETOWN CT
06457-2718
US

V. Phone/Fax

Practice location:
  • Phone: 860-664-0787
  • Fax: 860-638-6601
Mailing address:
  • Phone: 860-347-6971
  • Fax: 860-638-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000810
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: