Healthcare Provider Details

I. General information

NPI: 1487616769
Provider Name (Legal Business Name): CYNTHIA SCHROEDER RODRIGUEZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CASCADE WEST PKWY SE SUITE 240
GRAND RAPIDS MI
49546
US

IV. Provider business mailing address

500 CASCADE WEST PKWY SE SUITE 240
GRAND RAPIDS MI
49546
US

V. Phone/Fax

Practice location:
  • Phone: 616-591-9000
  • Fax: 616-591-9060
Mailing address:
  • Phone: 616-591-9000
  • Fax: 616-591-9060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301011626
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: