Provider Demographics
NPI:1447839782
Name:BRINKMAN, RACHELLE ELAINE
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:ELAINE
Last Name:BRINKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 RICHARD AVE
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2869
Mailing Address - Country:US
Mailing Address - Phone:218-673-7724
Mailing Address - Fax:
Practice Address - Street 1:4140 RICHARD AVE
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-2869
Practice Address - Country:US
Practice Address - Phone:218-673-7724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician