Healthcare Provider Details

I. General information

NPI: 1386711414
Provider Name (Legal Business Name): CHERYL PARENTE ROGGOW LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 PARK ST
PLAINWELL MI
49080-1655
US

IV. Provider business mailing address

319 PARK ST
PLAINWELL MI
49080-1655
US

V. Phone/Fax

Practice location:
  • Phone: 269-685-9401
  • Fax: 269-685-9403
Mailing address:
  • Phone: 269-685-9401
  • Fax: 269-685-9403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6802082512
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: