Individual
MIRELLA IVELLISE RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2135 WOODBURN DR SE, GRAND RAPIDS, MI 49546-4385
(616) 340-5387
Mailing address
542 EASTERN AVE NE APT 1, GRAND RAPIDS, MI 49503-1809
Taxonomy
Speciality
Code
Description
License number
State
225C00000X
Rehabilitation Counselor
Primary
—
—
Other
Enumeration date
09/25/2012
Last updated
09/25/2012
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