Provider Demographics
NPI:1285822536
Name:WISDOM-VIDAL, RACHEL (MSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:WISDOM-VIDAL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:WISDOM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:5397 SCHOOL HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547-2305
Mailing Address - Country:US
Mailing Address - Phone:970-218-0824
Mailing Address - Fax:
Practice Address - Street 1:315 N 11TH AVE BLDG A
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-2014
Practice Address - Country:US
Practice Address - Phone:970-400-6765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical