Healthcare Provider Details

I. General information

NPI: 1770829483
Provider Name (Legal Business Name): RACHEL ROSENBLATT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2012
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 ROHLWING RD STE C
ROLLING MEADOWS IL
60008-1300
US

IV. Provider business mailing address

1951 ROHLWING RD STE C
ROLLING MEADOWS IL
60008-1300
US

V. Phone/Fax

Practice location:
  • Phone: 920-857-9041
  • Fax: 920-857-3366
Mailing address:
  • Phone: 920-857-9041
  • Fax: 920-857-3366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-67150
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: