1285817478 NPI number — MRS. REBECCA JO-RADEMACHER LEWIS MA, LPC, CAADC, SST

Table of content: MRS. REBECCA JO-RADEMACHER LEWIS MA, LPC, CAADC, SST (NPI 1285817478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285817478 NPI number — MRS. REBECCA JO-RADEMACHER LEWIS MA, LPC, CAADC, SST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
REBECCA
Provider Middle Name:
JO-RADEMACHER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC, CAADC, SST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RADEMACHER
Provider Other First Name:
REBECCA
Provider Other Middle Name:
JO
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285817478
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 2147
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-770-0845
Provider Business Mailing Address Fax Number:
844-272-7476

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 E ELM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48162-2649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-770-0845
Provider Business Practice Location Address Fax Number:
844-272-7476
Provider Enumeration Date:
12/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  6401010301 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2604097 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com