Provider Demographics
NPI:1700247350
Name:RACKSTRAW, ANGELA (LICSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:RACKSTRAW
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 1:7650 CURRELL BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2257
Mailing Address - Country:US
Mailing Address - Phone:651-964-9293
Mailing Address - Fax:
Practice Address - Street 1:7650 CURRELL BLVD STE 305
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2257
Practice Address - Country:US
Practice Address - Phone:651-964-9293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical