Provider Demographics
NPI:1083469845
Name:MCCONNELL, RACHAEL MARIE (LSW)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:MARIE
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11392 W 124TH AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46303-8064
Mailing Address - Country:US
Mailing Address - Phone:715-919-1592
Mailing Address - Fax:
Practice Address - Street 1:11392 W 124TH AVE
Practice Address - Street 2:
Practice Address - City:CEDAR LAKE
Practice Address - State:IN
Practice Address - Zip Code:46303-8064
Practice Address - Country:US
Practice Address - Phone:715-919-1592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33011949A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker