Provider Demographics
NPI:1437770484
Name:WOODS, RACHAEL M (NON RN CLC)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:M
Last Name:WOODS
Suffix:
Gender:F
Credentials:NON RN CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 N RODGERS AVE
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-4847
Mailing Address - Country:US
Mailing Address - Phone:618-980-9832
Mailing Address - Fax:
Practice Address - Street 1:2224 N RODGERS AVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4847
Practice Address - Country:US
Practice Address - Phone:618-980-9832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPP-310906174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN