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General NPI Number Information
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NPI Number | 1245515576
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Entity Type | Organization
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Legal Business Name | SHERI RODRIGUEZ, LMSW, ACSW
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Dates
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Enumeration Date | 10/18/2011
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Last Update Date | 10/29/2011
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Provider Practice Location Address
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Address Line | 4328 KALAMAZOO AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-3609
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Country | US
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Telephone | 616-260-3559
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 LANCASHIRE DR SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-2534
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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 | OWNER/THERAPIST
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Name | SHERI RODRIGUEZ
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Credential | LMSW, ACSW
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Telephone | 616-260-3559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6801067666
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License Number State | MI
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