Rachel Grantham, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

301722 Issued in MN

Practice address

2330 Sioux TRL NW
Prior Lake, MN 55372-9077

Phone

(952) 496-6164

NPI assigned

Aug 29, 2011

Last updated

Aug 29, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Shakopee Mdewakanton Sioux Community

  dba Shakopee Dakota Clinic

  • Family Medicine Physician
  • Prior Lake, MN
  • NPI 1013933381
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1314576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314576000000",
    "number": "1043591506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 SIOUX TRL NW",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553729077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 SIOUX TRL NW",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553729077",
            "telephone_number": "952-496-6164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANTHAM",
        "first_name": "RACHEL",
        "credential": "LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-29",
        "last_updated": "2011-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "301722",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LADC LIC",
            "identifier": "301722",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laurah Wambui Githinji
• Shelby Lanae Gjelhaug, COTA
• Natalie Gomez
• Cornelia Gonser, RN
• Grace & Dignity Hospice Care, Inc
• Melanie Lynn Gray
• Melanie Greeninger
• Alisa Joanne Titze Grothe
• Karl M. Haemig, DDS
• Rebecka Hagen, BSN, MPH, NTP

• Addiction (Substance Use Disorder) Counselor in Prior Lake, MN
• Providers in Prior Lake, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.