Provider Demographics
NPI:1174761720
Name:BAKKER, ELIZABETH RACHEL (MS CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:RACHEL
Last Name:BAKKER
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12840 ALEXANDER STREET
Mailing Address - Street 2:
Mailing Address - City:CEDAR LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46303
Mailing Address - Country:US
Mailing Address - Phone:219-374-6454
Mailing Address - Fax:
Practice Address - Street 1:12840 ALEXANDER STREET
Practice Address - Street 2:
Practice Address - City:CEDAR LAKE
Practice Address - State:IN
Practice Address - Zip Code:46303
Practice Address - Country:US
Practice Address - Phone:219-374-6454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004327A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist