Provider Demographics
NPI:1982163721
Name:AULTMAN, RACHEL OLIVIA BRITT (LMSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:OLIVIA BRITT
Last Name:AULTMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:OLIVIA
Other - Last Name:BRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:AK
Mailing Address - Zip Code:99741-0052
Mailing Address - Country:US
Mailing Address - Phone:318-501-1123
Mailing Address - Fax:
Practice Address - Street 1:122 1ST AVE STE 600
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4899
Practice Address - Country:US
Practice Address - Phone:907-459-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1536311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK153631OtherMASTER SOCIAL WORKER
LA14304OtherLMSW LICENSE