Provider Demographics
NPI:1972870244
Name:WICKERSHAM, RACHEL DOLAN (CD(DONA), CPM, LM)
Entity type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:DOLAN
Last Name:WICKERSHAM
Suffix:
Gender:F
Credentials:CD(DONA), CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E KRAGE DR
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-4120
Mailing Address - Country:US
Mailing Address - Phone:630-750-9444
Mailing Address - Fax:630-832-3556
Practice Address - Street 1:901 E KRAGE DR
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-4120
Practice Address - Country:US
Practice Address - Phone:630-750-9444
Practice Address - Fax:630-832-3556
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2014-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI87-049176B00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula