Provider Demographics
NPI:1730721119
Name:HEWSON, RACHAEL JOSEPHINE (ATC)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:JOSEPHINE
Last Name:HEWSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 EASTWAY DR
Mailing Address - Street 2:
Mailing Address - City:ISLAND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60042-9450
Mailing Address - Country:US
Mailing Address - Phone:847-868-6962
Mailing Address - Fax:
Practice Address - Street 1:302 E EMERSON ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-1768
Practice Address - Country:US
Practice Address - Phone:847-868-6962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0047552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer