Provider Demographics
NPI:1336630532
Name:GHRIST, RACHEL MARIE (BS, MHP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:GHRIST
Suffix:
Gender:F
Credentials:BS, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 WOODLAWN RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-4151
Mailing Address - Country:US
Mailing Address - Phone:815-625-0013
Mailing Address - Fax:815-625-0197
Practice Address - Street 1:2611 WOODLAWN RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-4151
Practice Address - Country:US
Practice Address - Phone:815-625-0013
Practice Address - Fax:815-625-0197
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker