Provider Demographics
NPI:1508258971
Name:RANGEL, JACQUELYN RAE
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:RAE
Last Name:RANGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:RAE
Other - Last Name:SCHWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLBSW
Mailing Address - Street 1:1755 DELWOOD AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-5616
Mailing Address - Country:US
Mailing Address - Phone:616-455-0690
Mailing Address - Fax:616-455-7324
Practice Address - Street 1:1755 DELWOOD AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-5616
Practice Address - Country:US
Practice Address - Phone:616-455-0960
Practice Address - Fax:616-455-7324
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802087096251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management