Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6301012014 | MI |
Y | 103G00000X | Clinical Psychologist | 6301012014 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301012014 | MI |
N | 103TC1900X | Counseling Psychologist | 6301012014 | MI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 6301012014 | MI |
N | 103TH0004X | Health Psychologist | 6301012014 | MI |
N | 103TM1800X | Intellectual & Developmental Disabilities | 6301012014 | MI |
NPI | 1164694006 |
---|---|
Provider Name | Dr. Andrea Lee Rotzien |
First Address | Grand Rapids, MI 49525 |
Second Address | Grand Rapids, MI 49525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2008 |
Last Update Date | 06/06/2012 |