Provider Demographics
NPI:1427544063
Name:RAKE, JACQUELINE LILLIAN
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:LILLIAN
Last Name:RAKE
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 1:318 HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-1911
Mailing Address - Country:US
Mailing Address - Phone:616-319-4389
Mailing Address - Fax:
Practice Address - Street 1:318 HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-1911
Practice Address - Country:US
Practice Address - Phone:616-319-4389
Practice Address - Fax:616-226-4798
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker