Provider Demographics
NPI:1578962361
Name:HACKER, RHODA LOUISE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:RHODA
Middle Name:LOUISE
Last Name:HACKER
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 1:1504 HIAWATHA DR
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1460
Mailing Address - Country:US
Mailing Address - Phone:989-387-5680
Mailing Address - Fax:
Practice Address - Street 1:1504 HIAWATHA DR
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1460
Practice Address - Country:US
Practice Address - Phone:989-387-5680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010860421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical