Healthcare Provider Details

I. General information

NPI: 1427295773
Provider Name (Legal Business Name): REBECCA JO STEVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 DIVISION AVE S
GRAND RAPIDS MI
49507-2459
US

IV. Provider business mailing address

3589 ORIOLE AVE SW
WYOMING MI
49509-3442
US

V. Phone/Fax

Practice location:
  • Phone: 616-247-3815
  • Fax: 616-247-0450
Mailing address:
  • Phone: 616-988-1479
  • Fax: 616-247-0450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801089535
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801089535
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: