Healthcare Provider Details

I. General information

NPI: 1659817427
Provider Name (Legal Business Name): RACHEL DETTLEFF LMSW, CRADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL DETTLEFF-SCHMIDT LMSW, CRADC

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 LINDELL BLVD
SAINT LOUIS MO
63108-2914
US

IV. Provider business mailing address

4130 LINDELL BLVD
SAINT LOUIS MO
63108-2914
US

V. Phone/Fax

Practice location:
  • Phone: 314-535-5600
  • Fax: 314-535-6037
Mailing address:
  • Phone: 314-535-5600
  • Fax: 314-535-6037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number8878
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2013000349
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: