Provider Demographics
NPI:1033268362
Name:ROEDE, REBECCA LYNN (LBSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:ROEDE
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:EARDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11950 CAMP LAKE DR NE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345-9562
Mailing Address - Country:US
Mailing Address - Phone:616-887-8453
Mailing Address - Fax:
Practice Address - Street 1:1450 LEONARD ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5515
Practice Address - Country:US
Practice Address - Phone:616-774-8789
Practice Address - Fax:616-774-2072
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020770911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical