Provider Demographics
NPI:1427295773
Name:STEVENS, REBECCA JO
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JO
Last Name:STEVENS
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 1:3589 ORIOLE AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-3442
Mailing Address - Country:US
Mailing Address - Phone:616-988-1479
Mailing Address - Fax:616-247-0450
Practice Address - Street 1:1939 DIVISION AVE S
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-2459
Practice Address - Country:US
Practice Address - Phone:616-247-3815
Practice Address - Fax:616-247-0450
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801089535101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health