Provider Demographics
NPI:1598459034
Name:OMMEN, RACHEL EILEEN (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:EILEEN
Last Name:OMMEN
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 OAKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62712-5835
Mailing Address - Country:US
Mailing Address - Phone:217-416-6761
Mailing Address - Fax:
Practice Address - Street 1:2534 FARRAGUT DR STE 2
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-1466
Practice Address - Country:US
Practice Address - Phone:217-953-4660
Practice Address - Fax:888-972-6419
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.108409104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker