Provider Demographics
NPI:1306625272
Name:COLLINS, RAKEISHA YVONNE (BA)
Entity type:Individual
Prefix:
First Name:RAKEISHA
Middle Name:YVONNE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MISS
Other - First Name:RAKEISHA
Other - Middle Name:YVONNE
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4419 N RAVENSWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5802
Mailing Address - Country:US
Mailing Address - Phone:816-890-4597
Mailing Address - Fax:
Practice Address - Street 1:4419 N RAVENSWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5802
Practice Address - Country:US
Practice Address - Phone:816-890-4597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator