Healthcare Provider Details

I. General information

NPI: 1598459034
Provider Name (Legal Business Name): RACHEL EILEEN OMMEN MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2534 FARRAGUT DR STE 2
SPRINGFIELD IL
62704-1466
US

IV. Provider business mailing address

4001 OAKVIEW DR
SPRINGFIELD IL
62712-5835
US

V. Phone/Fax

Practice location:
  • Phone: 217-953-4660
  • Fax: 888-972-6419
Mailing address:
  • Phone: 217-416-6761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.108409
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: