Healthcare Provider Details

I. General information

NPI: 1669718649
Provider Name (Legal Business Name): RACHEL ANNE AUSTIN LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2012
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHERRY ST SE APT/SUITE
GRAND RAPIDS MI
49503-4526
US

IV. Provider business mailing address

3431 NAVAHO DR SW APT/SUITE
GRANDVILLE MI
49418-1984
US

V. Phone/Fax

Practice location:
  • Phone: 616-240-0859
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801095042
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: