MEDICARE: REBECCA MCDANIEL

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	1041C0700X	Clinical Social Worker	149018251	IL
2	1041C0700X	Clinical Social Worker	C012553	NC
3	1041C0700X	Clinical Social Worker	6801114859	MI

General Provider Information

NPI Number	:	1306207881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA MCDANIEL

Provider Business Mailing Address
First Line	:	309 WOODMERE AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-1724
Country	:	US
Telephone Number	:	708-420-4989
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 PEARL ST NW STE 341
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-3026
Country	:	US
Telephone Number	:	708-420-4989
Fax Number	:

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

Provider Enumeration Date	:	03/11/2016
Last Update Date	:	10/17/2023

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Directions to “ REBECCA MCDANIEL ” Practice Location

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