Healthcare Provider Details

I. General information

NPI: 1033829296
Provider Name (Legal Business Name): REBECCA PICCARD LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4448 5 MILE RD NW
GRAND RAPIDS MI
49544-9797
US

IV. Provider business mailing address

4448 5 MILE RD NW
GRAND RAPIDS MI
49544-9797
US

V. Phone/Fax

Practice location:
  • Phone: 616-260-2962
  • Fax:
Mailing address:
  • Phone: 616-260-2962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801121368
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: