Provider Demographics
NPI:1164620555
Name:ROHDE, MARY JO (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JO
Last Name:ROHDE
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 1:1201 STAMBOUGH AVE
Mailing Address - Street 2:
Mailing Address - City:IRON RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49935
Mailing Address - Country:US
Mailing Address - Phone:906-265-5096
Mailing Address - Fax:
Practice Address - Street 1:1201 STAMBOUGH AVE
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:MI
Practice Address - Zip Code:49935
Practice Address - Country:US
Practice Address - Phone:906-265-5096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010726121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical