Healthcare Provider Details

I. General information

NPI: 1003153594
Provider Name (Legal Business Name): VERONICA LYNN ROTHNEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VERONICA YOUNG LMSW

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 11/27/2023
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JOHN ST STE M-170
KALAMAZOO MI
49007-5366
US

IV. Provider business mailing address

610 S BURDICK ST
KALAMAZOO MI
49007-5221
US

V. Phone/Fax

Practice location:
  • Phone: 269-381-5060
  • Fax: 269-381-1655
Mailing address:
  • Phone: 269-381-3700
  • Fax: 269-381-3810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801094550
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: