Healthcare Provider Details

I. General information

NPI: 1205086923
Provider Name (Legal Business Name): RACHEL ANN SACKENHEIM MSW, LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9394 STERLING DR
WEST CHESTER OH
45241-5107
US

IV. Provider business mailing address

9394 STERLING DR
WEST CHESTER OH
45241-5107
US

V. Phone/Fax

Practice location:
  • Phone: 513-779-3014
  • Fax: 513-779-3494
Mailing address:
  • Phone: 513-779-3014
  • Fax: 513-779-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.1303087-SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.0701329.TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: