Provider Demographics
NPI:1710418215
Name:VANOVERBEKE, RACHEL ELIZABETH JOHNSTON (LICSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ELIZABETH JOHNSTON
Last Name:VANOVERBEKE
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 1:424 HARRISON AVE S
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8418
Mailing Address - Country:US
Mailing Address - Phone:507-380-5539
Mailing Address - Fax:
Practice Address - Street 1:424 HARRISON AVE S
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-8418
Practice Address - Country:US
Practice Address - Phone:507-380-5539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-26
Last Update Date:2017-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN228031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical