Healthcare Provider Details

I. General information

NPI: 1285591693
Provider Name (Legal Business Name): RACHAL AASA CROSS LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 HIGHWAY 371 S
HACKENSACK MN
56452-2638
US

IV. Provider business mailing address

203 4TH ST SW
SEBEKA MN
56477-2448
US

V. Phone/Fax

Practice location:
  • Phone: 218-675-5101
  • Fax: 651-925-0226
Mailing address:
  • Phone: 218-639-5113
  • Fax: 651-925-0226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number31279
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: