Provider Demographics
NPI:1841687084
Name:ROZENDAL, MARY S (PHD, ET/P)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:S
Last Name:ROZENDAL
Suffix:
Gender:F
Credentials:PHD, ET/P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 EAGLE PARK DR NE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-4569
Mailing Address - Country:US
Mailing Address - Phone:616-530-2224
Mailing Address - Fax:616-825-6164
Practice Address - Street 1:3260 EAGLE PARK DR NE
Practice Address - Street 2:SUITE 117
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-4569
Practice Address - Country:US
Practice Address - Phone:616-530-2224
Practice Address - Fax:616-825-6164
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor