Provider Demographics
NPI:1528591393
Name:ROSA, ERIN (LLMSW)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:SIETSEMA-ROSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLMSW
Mailing Address - Street 1:5010 DIVISION AVE S
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49548-5602
Mailing Address - Country:US
Mailing Address - Phone:616-862-0256
Mailing Address - Fax:
Practice Address - Street 1:3300 36TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-2810
Practice Address - Country:US
Practice Address - Phone:616-942-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010974631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical