Provider Demographics
NPI:1629258405
Name:BALLMER, RACHELLE (LICSW)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:BALLMER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14435
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98114-0435
Mailing Address - Country:US
Mailing Address - Phone:206-321-1299
Mailing Address - Fax:206-985-2698
Practice Address - Street 1:753 N 35TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8870
Practice Address - Country:US
Practice Address - Phone:206-321-1299
Practice Address - Fax:206-985-2698
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000059021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical