Provider Demographics
NPI:1972186013
Name:HENKEL, RACHELLE M (MSW)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:M
Last Name:HENKEL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:M
Other - Last Name:ERDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11394 LEAH CT
Mailing Address - Street 2:
Mailing Address - City:CHISAGO CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55013-9727
Mailing Address - Country:US
Mailing Address - Phone:715-220-8743
Mailing Address - Fax:
Practice Address - Street 1:7525 VILLAGE DR STE 130
Practice Address - Street 2:
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-1305
Practice Address - Country:US
Practice Address - Phone:715-220-8743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN192791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA