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General NPI Number Information
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NPI Number | 1366935603
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Entity Type | Individual
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Provider Name | CAMDEN L BAUCKE
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Gender | Male
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 3249 BROAD ST STE 1
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City | DEXTER
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State | MI
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Zip | 48130-1018
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Country | US
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Telephone | 734-219-3907
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Fax | 734-418-9110
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Provider Business Mailing Address
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Address Line | 3249 BROAD ST STE 1
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City | DEXTER
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State | MI
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Zip | 48130-1018
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Country | US
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Telephone | 734-219-3907
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Fax | 734-418-9110
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6361007949
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License Number State | MI
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