Provider Demographics
NPI:1245878685
Name:KERN, RACHEL DIANNE (LLP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:DIANNE
Last Name:KERN
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:DIANNE
Other - Last Name:KERN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLP
Mailing Address - Street 1:1660 FORT ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2003
Mailing Address - Country:US
Mailing Address - Phone:248-921-1495
Mailing Address - Fax:
Practice Address - Street 1:1660 FORT ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2003
Practice Address - Country:US
Practice Address - Phone:248-921-1495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017769103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist