Provider Demographics
NPI:1407301245
Name:RAKO, ANDREA L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:L
Last Name:RAKO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:L
Other - Last Name:SCHICKEDANZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1500 VICKSBURG DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-5806
Mailing Address - Country:US
Mailing Address - Phone:618-977-0041
Mailing Address - Fax:
Practice Address - Street 1:1500 VICKSBURG DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-5806
Practice Address - Country:US
Practice Address - Phone:618-977-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0069661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical