Healthcare Provider Details

I. General information

NPI: 1053227199
Provider Name (Legal Business Name): BROOKE ALEXANDRA BAUGHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 BECKER DR APT E101
ALLENDALE MI
49401-8622
US

IV. Provider business mailing address

4815 BECKER DR APT E101
ALLENDALE MI
49401-8622
US

V. Phone/Fax

Practice location:
  • Phone: 269-548-5057
  • Fax:
Mailing address:
  • Phone: 269-548-5057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number2703220
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: