Healthcare Provider Details

I. General information

NPI: 1275255374
Provider Name (Legal Business Name): RACHEL ELLEN MAXON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E VETERANS STREET
TOMAH WI
54660
US

IV. Provider business mailing address

500 E VETERANS STREET
TOMAH WI
54660
US

V. Phone/Fax

Practice location:
  • Phone: 608-372-3971
  • Fax: 608-374-8201
Mailing address:
  • Phone: 608-372-3971
  • Fax: 608-374-8201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11545-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: