Provider Demographics
NPI:1679096382
Name:CLARK, RACHAEL KRISTIN (MSW)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:KRISTIN
Last Name:CLARK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 ABSAROKA TRL
Mailing Address - Street 2:
Mailing Address - City:BAR NUNN
Mailing Address - State:WY
Mailing Address - Zip Code:82601-7525
Mailing Address - Country:US
Mailing Address - Phone:307-315-3651
Mailing Address - Fax:
Practice Address - Street 1:2317 ABSAROKA TRAIL
Practice Address - Street 2:
Practice Address - City:BAR NUNN
Practice Address - State:WY
Practice Address - Zip Code:82601
Practice Address - Country:US
Practice Address - Phone:307-315-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management