Healthcare Provider Details

I. General information

NPI: 1053215079
Provider Name (Legal Business Name): RACHEL JUSTICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 S KANSAS EXPY
SPRINGFIELD MO
65807-5969
US

IV. Provider business mailing address

2436 E WILLOW
REPUBLIC MO
65738-7576
US

V. Phone/Fax

Practice location:
  • Phone: 417-429-1780
  • Fax:
Mailing address:
  • Phone: 417-429-1780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2026047713
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: