Provider Demographics
NPI:1083946081
Name:CLARK, RACHEL MAE (MS, CGC)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:MAE
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:MAE
Other - Last Name:KLUEMPKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:9600 UPLAND LN N
Mailing Address - Street 2:STE 180
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4494
Mailing Address - Country:US
Mailing Address - Phone:763-236-0753
Mailing Address - Fax:763-236-0751
Practice Address - Street 1:9600 UPLAND LN N
Practice Address - Street 2:STE 180
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4494
Practice Address - Country:US
Practice Address - Phone:763-236-0753
Practice Address - Fax:763-236-0751
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS