Provider Demographics
NPI:1942808290
Name:OURADA, RACHEL KRISTI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:KRISTI
Last Name:OURADA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4248 SARATOGA AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1959
Mailing Address - Country:US
Mailing Address - Phone:630-677-7224
Mailing Address - Fax:
Practice Address - Street 1:2542 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-5216
Practice Address - Country:US
Practice Address - Phone:773-365-7277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490225651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149022565OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION