Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6801090932 | MI |
NPI | 1003236662 |
---|---|
Provider Name | Mrs. Ruqaiyah Shariah Rogers |
First Address | Grand Rapids, MI 49510-7215 |
Second Address | Grand Rapids, MI 49525-9747 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2014 |
Last Update Date | 29/05/2014 |