Provider Demographics
NPI:1639755226
Name:HALEN, RACHEL SAMANATHA
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:SAMANATHA
Last Name:HALEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4946 N SPAULDING AVE APT GS
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-7299
Mailing Address - Country:US
Mailing Address - Phone:775-220-6982
Mailing Address - Fax:
Practice Address - Street 1:4101 N RAVENSWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2193
Practice Address - Country:US
Practice Address - Phone:773-572-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490227401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical