Provider Demographics
NPI:1821038225
Name:OETJENS, REBECCA E (PHD LP)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:E
Last Name:OETJENS
Suffix:
Gender:F
Credentials:PHD LP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:SPURCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1348 EAST FAIRVIEW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306
Mailing Address - Country:US
Mailing Address - Phone:248-652-6301
Mailing Address - Fax:
Practice Address - Street 1:3950 S ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5160
Practice Address - Country:US
Practice Address - Phone:248-844-6234
Practice Address - Fax:248-844-6237
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002685103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1705289Medicaid
MI1705289Medicaid