=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366121055
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL LYNN LINDOW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2023
-----------------------------------------------------
Last Update Date | 09/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2285 BENDEN DR
-----------------------------------------------------
City | WOOSTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44691-2568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-364-9029
-----------------------------------------------------
Fax | 330-263-7251
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2285 BENDEN DR
-----------------------------------------------------
City | WOOSTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44691-2568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-364-9029
-----------------------------------------------------
Fax | 330-263-7251
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | S.2410710
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number | YPS.000021
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------