Provider Demographics
NPI:1578699831
Name:ROUSTER, GRETCHEN LYNN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:LYNN
Last Name:ROUSTER
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 1:466 MARION ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2015
Mailing Address - Country:US
Mailing Address - Phone:734-480-2071
Mailing Address - Fax:
Practice Address - Street 1:3830 PACKARD ST
Practice Address - Street 2:SUITE 250
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2051
Practice Address - Country:US
Practice Address - Phone:734-657-5247
Practice Address - Fax:734-975-2909
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801058490104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker