Provider Demographics
NPI:1992732176
Name:BAXTER, KATHERINE RHEAUME (LMSW, CAADC, CCDP-D)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:RHEAUME
Last Name:BAXTER
Suffix:
Gender:F
Credentials:LMSW, CAADC, CCDP-D
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:ANNE
Other - Last Name:RHEAUME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5054 PIERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIAVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48421-9343
Mailing Address - Country:US
Mailing Address - Phone:810-793-6794
Mailing Address - Fax:
Practice Address - Street 1:420 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2445
Practice Address - Country:US
Practice Address - Phone:810-496-4910
Practice Address - Fax:810-496-4922
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010670891041C0700X
MIC-00472101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
0998084OtherHEALTH PLUS
11558877OtherAETNA