MEDICARE: REBECCA LYNN ROEDE LBSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	6802077091	MI

General Provider Information

NPI Number	:	1033268362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA LYNN ROEDE LBSW

Provider Business Mailing Address
First Line	:	11950 CAMP LAKE DR NE
Second Line	:
City	:	SPARTA
State	:	MI
Zip	:	49345-9562
Country	:	US
Telephone Number	:	616-887-8453
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 LEONARD ST NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-5515
Country	:	US
Telephone Number	:	616-774-8789
Fax Number	:	616-774-2072

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	10/01/2025

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