Provider Demographics
NPI:1821301623
Name:ASHFORD, RACHEL GABRIELLE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:GABRIELLE
Last Name:ASHFORD
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 1:5107 E SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-2475
Mailing Address - Country:US
Mailing Address - Phone:218-461-1693
Mailing Address - Fax:
Practice Address - Street 1:5107 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55804
Practice Address - Country:US
Practice Address - Phone:218-461-1693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-4251041C0700X
MN213371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1821301623Medicaid
MN1821301623Medicaid