Healthcare Provider Details

I. General information

NPI: 1497152656
Provider Name (Legal Business Name): RACHEL E KOWALCZYK RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 SOUTH MAIN ST
MEDFORD WI
54451
US

IV. Provider business mailing address

413 N 17TH AVE
WAUSAU WI
54401-4611
US

V. Phone/Fax

Practice location:
  • Phone: 715-748-5435
  • Fax:
Mailing address:
  • Phone: 715-842-4649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: