Individual
MR. GERALDINE TAECKENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ACSW
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
L867363
MI
106H00000X
Marriage & Family Therapist
L867363
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8008924810
BCBS
MI
Enumeration date
03/26/2007
Last updated
07/25/2011
Update your record
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