Healthcare Provider Details

I. General information

NPI: 1487316535
Provider Name (Legal Business Name): RACHEL H RUTKOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6705 WHITE HORSE RD
GREENVILLE SC
29611-2503
US

IV. Provider business mailing address

14 SKYLAND DR
GREENVILLE SC
29607-1944
US

V. Phone/Fax

Practice location:
  • Phone: 704-654-8599
  • Fax:
Mailing address:
  • Phone: 803-931-2425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-79037
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: