Provider Demographics
NPI:1821893819
Name:BECKER, CONNIE LYNNE (CPHT)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:LYNNE
Last Name:BECKER
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E BIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-1800
Mailing Address - Country:US
Mailing Address - Phone:517-783-3434
Mailing Address - Fax:
Practice Address - Street 1:212 E BIDDLE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-1800
Practice Address - Country:US
Practice Address - Phone:517-783-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303014271172V00000X, 183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No183700000XPharmacy Service ProvidersPharmacy Technician