Provider Demographics
NPI:1114598414
Name:WINTER, RACHEL LYNN (LICSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:WINTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 SUMMERFIELD DR APT 29
Mailing Address - Street 2:
Mailing Address - City:CROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56716-2670
Mailing Address - Country:US
Mailing Address - Phone:218-770-0087
Mailing Address - Fax:
Practice Address - Street 1:603 BRUCE ST
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-2914
Practice Address - Country:US
Practice Address - Phone:218-280-3933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical