Provider Demographics
NPI:1154404838
Name:VIZINA-ROUBAL, JANET LYNN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:LYNN
Last Name:VIZINA-ROUBAL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3298 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4725
Mailing Address - Country:US
Mailing Address - Phone:231-715-8466
Mailing Address - Fax:231-943-2263
Practice Address - Street 1:500 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-9501
Practice Address - Country:US
Practice Address - Phone:231-796-5825
Practice Address - Fax:231-796-2178
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010851751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical