Provider Demographics
NPI:1336615467
Name:RODEMS, ELIZABETH DERBY SAMMONS (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:DERBY SAMMONS
Last Name:RODEMS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:DERBY
Other - Last Name:SAMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2704 GLENBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6728
Mailing Address - Country:US
Mailing Address - Phone:419-350-2805
Mailing Address - Fax:
Practice Address - Street 1:2245 S STATE ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6184
Practice Address - Country:US
Practice Address - Phone:734-769-0209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010918321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical