Healthcare Provider Details

I. General information

NPI: 1144219718
Provider Name (Legal Business Name): RACHEL POTHAST M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E SUPERIOR ST RM 5-2221
CHICAGO IL
60611-2914
US

IV. Provider business mailing address

250 E SUPERIOR ST RM 5-2221
CHICAGO IL
60611-2914
US

V. Phone/Fax

Practice location:
  • Phone: 312-472-4152
  • Fax: 312-472-4564
Mailing address:
  • Phone: 312-472-4152
  • Fax: 312-472-4564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: