Provider Demographics
NPI:1295565927
Name:BAXTER, RAYA GRACE
Entity type:Individual
Prefix:
First Name:RAYA
Middle Name:GRACE
Last Name:BAXTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 A AVE NE
Mailing Address - Street 2:
Mailing Address - City:WALFORD
Mailing Address - State:IA
Mailing Address - Zip Code:52351-8017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 BELL DR SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-7406
Practice Address - Country:US
Practice Address - Phone:319-294-9577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician