Provider Demographics
NPI:1093316051
Name:BAEZA, RACHAEL
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:BAEZA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202639 E COUNTY ROAD 42
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-5442
Mailing Address - Country:US
Mailing Address - Phone:580-808-2013
Mailing Address - Fax:580-254-5335
Practice Address - Street 1:202639 E COUNTY ROAD 42
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-5442
Practice Address - Country:US
Practice Address - Phone:580-808-2013
Practice Address - Fax:580-254-5335
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK21444-P1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator