Healthcare Provider Details

I. General information

NPI: 1871244806
Provider Name (Legal Business Name): REBECCA STENGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28475 GREENFIELD RD STE 113
SOUTHFIELD MI
48076-3034
US

IV. Provider business mailing address

162 HERON DR NW APT 205G
GRAND RAPIDS MI
49534-1607
US

V. Phone/Fax

Practice location:
  • Phone: 248-792-8273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361008281
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: