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General NPI Number Information
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NPI Number | 1235946229
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Entity Type | Organization
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Legal Business Name | ROGUE THERAPY PLLC
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 240 E SPARTAN DR
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City | SPARTA
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State | MI
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Zip | 49345-1449
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Country | US
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Telephone | 616-887-1743
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Fax |
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Provider Business Mailing Address
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Address Line | 2913 5TH ST APT 1
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City | MUSKEGON
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State | MI
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Zip | 49444-2072
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | CAITLIN OLIVER
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Credential | LMSW
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Telephone | 616-634-6949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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