Individual
RACHAL GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6013 S REDWOOD RD, SALT LAKE CITY, UT 84123-5220
(801) 255-5131
Mailing address
6013 S REDWOOD RD, SALT LAKE CITY, UT 84123-5220
(801) 255-5131
(801) 255-5131
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
8368793-2506
UT
1041C0700X
Clinical Social Worker
Primary
8368793-3502
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260022408
RAILROAD MEDICARE
UT
05
—
876000308007
—
UT
Enumeration date
08/09/2011
Last updated
01/17/2022
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