Healthcare Provider Details

I. General information

NPI: 1235702879
Provider Name (Legal Business Name): KATIE JO RHODES LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 WEALTHY ST SE STE 246
GRAND RAPIDS MI
49506-2755
US

IV. Provider business mailing address

2479 APPLETON DR NE
GRAND RAPIDS MI
49525-3171
US

V. Phone/Fax

Practice location:
  • Phone: 616-259-5419
  • Fax:
Mailing address:
  • Phone: 309-830-3922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401019398
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: