Provider Demographics
NPI:1871358291
Name:DAULT, REBEKAH JOAN (CHW)
Entity type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:JOAN
Last Name:DAULT
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-3319
Mailing Address - Country:US
Mailing Address - Phone:989-529-5803
Mailing Address - Fax:
Practice Address - Street 1:1615 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-3319
Practice Address - Country:US
Practice Address - Phone:989-893-4506
Practice Address - Fax:989-893-3770
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker