Provider Demographics
NPI:1689738320
Name:BEAUDRY-RODGERS, KELLY ANN (MS, CGC)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANN
Last Name:BEAUDRY-RODGERS
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 W 13 MILE RD
Mailing Address - Street 2:SUITE 329
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6710
Mailing Address - Country:US
Mailing Address - Phone:248-441-0395
Mailing Address - Fax:248-551-3130
Practice Address - Street 1:3535 W 13 MILE RD STE N300
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6770
Practice Address - Country:US
Practice Address - Phone:248-551-3302
Practice Address - Fax:248-551-7373
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
170300000X
MI7201000148170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS