Healthcare Provider Details

I. General information

NPI: 1508490905
Provider Name (Legal Business Name): REBECCA BAKKER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA SCOTT

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11280 86TH AVE N
MAPLE GROVE MN
55369-4510
US

IV. Provider business mailing address

12425 WATERSIDE CT
ROGERS MN
55374-3300
US

V. Phone/Fax

Practice location:
  • Phone: 763-400-7828
  • Fax:
Mailing address:
  • Phone: 724-261-7703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: