Provider Demographics
NPI:1306683495
Name:ROOP, MADELYN
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:
Last Name:ROOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-1965
Mailing Address - Country:US
Mailing Address - Phone:248-884-2519
Mailing Address - Fax:
Practice Address - Street 1:1475 ROBBINS RD STE 150
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-3700
Practice Address - Country:US
Practice Address - Phone:616-797-8471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
68511187731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical