Healthcare Provider Details

I. General information

NPI: 1306435862
Provider Name (Legal Business Name): RACHAEL K GOINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3948 N SHERIDAN RD
CHICAGO IL
60613-2935
US

IV. Provider business mailing address

4025 N SHERIDAN RD
CHICAGO IL
60613-2010
US

V. Phone/Fax

Practice location:
  • Phone: 773-388-1600
  • Fax: 773-388-8664
Mailing address:
  • Phone: 773-388-1600
  • Fax: 773-388-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.022847
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: