Provider Demographics
NPI:1104023522
Name:RAFFENAUD-MACKER, ANN ELAINE (LLPC)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:ELAINE
Last Name:RAFFENAUD-MACKER
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 PARTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KINCHELOE
Mailing Address - State:MI
Mailing Address - Zip Code:49788-1305
Mailing Address - Country:US
Mailing Address - Phone:616-706-6755
Mailing Address - Fax:
Practice Address - Street 1:605 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-3111
Practice Address - Country:US
Practice Address - Phone:906-635-7270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009730251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health