Healthcare Provider Details

I. General information

NPI: 1306058508
Provider Name (Legal Business Name): RACHEL P MIKULA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 W BYRON ST
CHICAGO IL
60641-2712
US

IV. Provider business mailing address

419 E PARK AVE
ELMHURST IL
60126-3609
US

V. Phone/Fax

Practice location:
  • Phone: 773-282-7800
  • Fax: 773-282-2163
Mailing address:
  • Phone: 773-282-7800
  • Fax: 773-282-2163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: