Healthcare Provider Details

I. General information

NPI: 1669703294
Provider Name (Legal Business Name): RACHEL BAUKS CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 E LINCOLNWAY
CHEYENNE WY
82001-4703
US

IV. Provider business mailing address

721 E LINCOLNWAY
CHEYENNE WY
82001-4703
US

V. Phone/Fax

Practice location:
  • Phone: 307-256-6467
  • Fax: 307-637-6852
Mailing address:
  • Phone: 307-421-5928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number190
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPCSW-912
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: