Provider Demographics
NPI:1760002505
Name:WOLTER, RACHAEL (MS)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:WOLTER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4983 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9760
Mailing Address - Country:US
Mailing Address - Phone:314-690-5379
Mailing Address - Fax:
Practice Address - Street 1:4983 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9760
Practice Address - Country:US
Practice Address - Phone:330-416-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC2002579101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health