Provider Demographics
NPI:1669126595
Name:ROHDE, LYDIA
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:ROHDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2962 ROUNDTREE BLVD # B1
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-4811
Mailing Address - Country:US
Mailing Address - Phone:262-825-6051
Mailing Address - Fax:
Practice Address - Street 1:16650 GLENDALE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-1210
Practice Address - Country:US
Practice Address - Phone:262-825-6051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker