Provider Demographics
NPI:1447873765
Name:YAW, RACHEL J (LCSW)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:J
Last Name:YAW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JACOB
Mailing Address - State:IL
Mailing Address - Zip Code:62281-1572
Mailing Address - Country:US
Mailing Address - Phone:618-978-7463
Mailing Address - Fax:
Practice Address - Street 1:1123 LOCUST ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63101-1103
Practice Address - Country:US
Practice Address - Phone:314-240-5104
Practice Address - Fax:314-492-4009
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130194291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty