Healthcare Provider Details

I. General information

NPI: 1053283846
Provider Name (Legal Business Name): RACHAEL MOUW LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/22/2025
Certification Date: 09/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 KRAFT AVE SE STE 186
GRAND RAPIDS MI
49512-2076
US

IV. Provider business mailing address

2604 FLORLEN AVE NE
GRAND RAPIDS MI
49525-3968
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-9550
  • Fax: 616-949-9551
Mailing address:
  • Phone: 616-949-9550
  • Fax: 616-949-9551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851120964
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: