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General NPI Number Information
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NPI Number | 1770482838
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Entity Type | Individual
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Provider Name | MRS. JENNIFER MCCUNE BAKOS
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Gender | Female
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Dates
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Enumeration Date | 11/04/2026
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Last Update Date | 11/04/2026
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Provider Practice Location Address
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Address Line | 8107 MUSTANG DR
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City | PORTAGE
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State | MI
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Zip | 49002-5577
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Country | US
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Telephone | 269-323-5479
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Fax |
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Provider Business Mailing Address
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Address Line | 9847 SHEPHARD RDG
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City | KALAMAZOO
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State | MI
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Zip | 49009-7498
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Country | US
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Telephone | 269-323-5479
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Fax |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7101002728
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License Number State | MI
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