Provider Demographics
NPI:1114408085
Name:BOOKENBERGER, RANDI N (CDCA & QMHS)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:N
Last Name:BOOKENBERGER
Suffix:
Gender:F
Credentials:CDCA & QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5267
Mailing Address - Country:US
Mailing Address - Phone:419-330-5122
Mailing Address - Fax:
Practice Address - Street 1:1725 UPTON ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-2551
Practice Address - Country:US
Practice Address - Phone:419-782-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health