MEDICARE: RACHELLE M HENKEL MSW

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	1041C0700X	Clinical Social Worker	19279	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NA	OTHER		NA

General Provider Information

NPI Number	:	1972186013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHELLE M HENKEL MSW

Provider Business Mailing Address
First Line	:	11394 LEAH CT
Second Line	:
City	:	CHISAGO CITY
State	:	MN
Zip	:	55013-9727
Country	:	US
Telephone Number	:	715-220-8743
Fax Number	:

Provider Business Practice Location Address
First Line	:	7525 VILLAGE DR STE 130
Second Line	:
City	:	LINO LAKES
State	:	MN
Zip	:	55014-1305
Country	:	US
Telephone Number	:	715-220-8743
Fax Number	:

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

Provider Enumeration Date	:	05/05/2021
Last Update Date	:	05/05/2021

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