MEDICARE: RACHEL MARIE PACKEE LPC-SASD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	17160-130	WI

General Provider Information

NPI Number	:	1134535990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL MARIE PACKEE LPC-SASD

Provider Business Mailing Address
First Line	:	714 E CUDAHY AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-5206
Country	:	US
Telephone Number	:	414-559-1276
Fax Number	:

Provider Business Practice Location Address
First Line	:	10012 W CAPITOL DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-1338
Country	:	US
Telephone Number	:	414-810-4844
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2014
Last Update Date	:	03/17/2018

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