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1215379185 NPI number — RACHEL FOWKE LCSW LMSW CSAC CAADC

NPI Number: 1215379185
Health Care Provider/Practitioner: RACHEL FOWKE LCSW LMSW CSAC CAADC

Information about “1215379185” NPI (RACHEL FOWKE LCSW LMSW CSAC CAADC) exists in 1215379185 in HTML format HTML  |  1215379185 in plain Text format TXT  |  1215379185 in PDF (Portable Document Format) PDF  |  1215379185 in an XML format XML  formats.

NPI Number : 1215379185 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215379185",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FOWKE",
    "FirstName": "RACHEL",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW LMSW CSAC CAADC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 232",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROMEO",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48065-0232",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "586-651-9324",
    "MailingAddressFaxNumber": "833-843-7621",
    "FirstLinePracticeLocationAddress": "16950 19 MILE RD STE 3H",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CLINTON TWP",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48038-4806",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "586-651-9324",
    "PracticeLocationAddressFaxNumber": "833-843-7621",
    "EnumerationDate": "07/22/2013",
    "LastUpdateDate": "07/21/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "LCSW-4130",
          "LicenseNumberStateCode": "HI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "6801094943",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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