Provider Demographics
NPI:1376676668
Name:PATIS, RACHEL BRIDGET (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:BRIDGET
Last Name:PATIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9092 W EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-3914
Mailing Address - Country:US
Mailing Address - Phone:312-399-5183
Mailing Address - Fax:
Practice Address - Street 1:101 S BROADWAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-4276
Practice Address - Country:US
Practice Address - Phone:630-859-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical