Healthcare Provider Details

I. General information

NPI: 1831794965
Provider Name (Legal Business Name): KRYSTAL ELIZABETH RAINWATER-BAKER LCSW/LMSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 E OHIO ST
FARWELL MI
48622-9337
US

IV. Provider business mailing address

4983 RUBY DR
GLADWIN MI
48624-8922
US

V. Phone/Fax

Practice location:
  • Phone: 218-779-7712
  • Fax:
Mailing address:
  • Phone: 218-779-7712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09927060
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801119090
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSS0000001210341
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: