Healthcare Provider Details

I. General information

NPI: 1144799255
Provider Name (Legal Business Name): RACHEL E HEGSETH LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 GOOD COUNSEL DR
MANKATO MN
56001-6599
US

IV. Provider business mailing address

W175N11120 STONEWOOD DR
GERMANTOWN WI
53022-6511
US

V. Phone/Fax

Practice location:
  • Phone: 800-438-1772
  • Fax: 262-345-5562
Mailing address:
  • Phone: 262-345-5533
  • Fax: 262-293-9737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number305230
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: