Healthcare Provider Details

I. General information

NPI: 1932618816
Provider Name (Legal Business Name): RACHEL GAGEL RISLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2017
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 JEFFERSON ST
ALGONQUIN IL
60102-2609
US

IV. Provider business mailing address

2724 BLACKJACK OAK CT
GASTONIA NC
28056-0035
US

V. Phone/Fax

Practice location:
  • Phone: 847-250-1829
  • Fax:
Mailing address:
  • Phone: 847-543-4122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149016456
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14467
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC014016
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: