Provider Demographics
NPI:1720803349
Name:SPRINGETT, REBECCA (SST)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SPRINGETT
Suffix:
Gender:F
Credentials:SST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35190 56TH ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:MI
Mailing Address - Zip Code:49013-9750
Mailing Address - Country:US
Mailing Address - Phone:269-547-7755
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 177
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:MI
Practice Address - Zip Code:49013-0177
Practice Address - Country:US
Practice Address - Phone:269-427-6623
Practice Address - Fax:269-427-1012
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803080100251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health