Healthcare Provider Details

I. General information

NPI: 1700279619
Provider Name (Legal Business Name): RHEA L VACHA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RHEA L ELLESTAD CAPSW

II. Dates (important events)

Enumeration Date: 03/17/2015
Last Update Date: 03/24/2024
Certification Date: 03/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W MIFFLIN ST STE 502
MADISON WI
53703-2589
US

IV. Provider business mailing address

742 CRESTHAVEN DR
COTTAGE GROVE WI
53527-9677
US

V. Phone/Fax

Practice location:
  • Phone: 608-513-9637
  • Fax:
Mailing address:
  • Phone: 608-513-9637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9393-123
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number129639-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: