Provider Demographics
NPI:1356725162
Name:DOZER, RACHAEL ANN (LCSW, CSAC)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ANN
Last Name:DOZER
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:ANN
Other - Last Name:FREDERICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APSW, SAC-IT
Mailing Address - Street 1:S2845 WHITE EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-9064
Mailing Address - Country:US
Mailing Address - Phone:715-355-1240
Mailing Address - Fax:715-355-9588
Practice Address - Street 1:S2845 WHITE EAGLE RD
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-9064
Practice Address - Country:US
Practice Address - Phone:715-355-1240
Practice Address - Fax:715-355-9588
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18118101YA0400X
WI90881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100046416Medicaid