Healthcare Provider Details

I. General information

NPI: 1720803349
Provider Name (Legal Business Name): REBECCA SPRINGETT SST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 177
BANGOR MI
49013-0177
US

IV. Provider business mailing address

35190 56TH ST
BANGOR MI
49013-9750
US

V. Phone/Fax

Practice location:
  • Phone: 269-427-6623
  • Fax: 269-427-1012
Mailing address:
  • Phone: 269-547-7755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6803080100
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: