Provider Demographics
NPI:1497080550
Name:SCARBROUGH, REBECCA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:SCARBROUGH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:WENK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1900 44TH ST SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2144 E PARIS AVE SE STE 200
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6126
Practice Address - Country:US
Practice Address - Phone:616-685-2100
Practice Address - Fax:616-685-2111
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 000096561041C0700X
MI68010869341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical