Provider Demographics
NPI:1881402964
Name:BAKKER, RACHEL E
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:E
Last Name:BAKKER
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 1:4071 SANCTUARY DR
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-9234
Mailing Address - Country:US
Mailing Address - Phone:989-289-2100
Mailing Address - Fax:
Practice Address - Street 1:4071 SANCTUARY DR
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-9234
Practice Address - Country:US
Practice Address - Phone:989-289-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician