Individual
IRAIDA RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD LLP
Contact information
Practice address
3355 EAGLE PARK DR NE STE 106, GRAND RAPIDS, MI 49525-7004
(616) 942-8060
(616) 942-6690
Mailing address
PO BOX 30516 DEPT 6001A, LANSING, MI 48909
(616) 942-8060
(616) 942-6690
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301009885
MI
Other
Enumeration date
09/20/2006
Last updated
07/08/2007
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