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NPI Code Detail

MEDICARE: RACHAL GREEN

MEDICARE: RACHAL GREEN
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
1103K00000XBehavior Analyst8368793-2506UT
21041C0700XClinical Social Worker8368793-3502UT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1260022408OTHERUTRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275812166
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHAL GREEN
Provider Business Mailing Address
First Line : 6013 S REDWOOD RD
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84123-5220
Country : US
Telephone Number : 801-255-5131
Fax Number : 801-255-5131
Provider Business Practice Location Address
First Line : 6013 S REDWOOD RD
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84123-5220
Country : US
Telephone Number : 801-255-5131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2011
Last Update Date : 01/17/2022

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Directions to “ RACHAL GREEN ” Practice Location

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