MEDICARE: RACHAEL PROFFITT

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	171M00000X	Case Manager/Care Coordinator
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	186540	OH

General Provider Information

NPI Number	:	1710669981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHAEL PROFFITT

Provider Business Mailing Address
First Line	:	219 VICTOR AVE APT 4
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-3750
Country	:	US
Telephone Number	:	937-271-5055
Fax Number	:

Provider Business Practice Location Address
First Line	:	1715 SPRINGFIELD ST STE 8B
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45403-1431
Country	:	US
Telephone Number	:	937-723-8854
Fax Number	:	937-637-8385

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

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	12/13/2023

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Directions to “ RACHAEL PROFFITT ” Practice Location

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