Provider Demographics
NPI:1043359144
Name:SUGGITT, REBECCA J (LMSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:SUGGITT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 PARCHMENT DR SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2307
Mailing Address - Country:US
Mailing Address - Phone:616-957-7700
Mailing Address - Fax:616-957-7773
Practice Address - Street 1:826 PARCHMENT DR SE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2307
Practice Address - Country:US
Practice Address - Phone:616-957-7700
Practice Address - Fax:616-957-7773
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010863261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4483587Medicaid
MI4483587Medicaid