Healthcare Provider Details

I. General information

NPI: 1205594470
Provider Name (Legal Business Name): RACHEL LAVOI LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 VETERANS DR
SAINT CLOUD MN
56303-2099
US

IV. Provider business mailing address

4801 VETERANS DR
SAINT CLOUD MN
56303-2099
US

V. Phone/Fax

Practice location:
  • Phone: 320-469-1602
  • Fax: 320-255-6423
Mailing address:
  • Phone: 320-469-1602
  • Fax: 320-255-6423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28174
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: