Rachel D Wickstrom, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

300551 Issued in MN

Practice address

332 W Superior St
Duluth, MN 55802-1808

Phone

(218) 722-4379

NPI assigned

May 15, 2022

Last updated

May 15, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1652572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652572800000",
    "number": "1295472959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1624 GRAHAM LAKE RD",
            "city": "HOLYOKE",
            "state": "MN",
            "postal_code": "557499519",
            "telephone_number": "218-391-2508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "332 W SUPERIOR ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558021808",
            "telephone_number": "218-722-4379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKSTROM",
        "first_name": "RACHEL",
        "middle_name": "D",
        "credential": "LADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-15",
        "last_updated": "2022-05-15",
        "certification_date": "2022-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "300551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Nystrom",
            "affiliation": "N",
            "endpointDescription": "SUD Treatment",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "SUD information",
            "address_1": "332 W Superior St",
            "city": "Duluth",
            "state": "MN",
            "country_code": "US",
            "postal_code": "558021808",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Chloe M Whittington, LICSW
• Anne B Whitworth, MD
• Savanna Wick
• Amy Wicker, O.T., LICSW
• Julie Katherine Wicker, MSW
• Luke David Widstrom, D.O.
• Mark Kenneth Widstrom
• Jason Wiederin, MD
• Joshua Daniel Wiederin, M.D.
• Jolee Kathleen Wiediger

• Addiction (Substance Use Disorder) Counselor in Duluth, MN
• Providers in Duluth, 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 May 15, 2022; 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.