Organization
RECONCILIATION OF LIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WANDA ANN ROGERS MA, EDD (DIRECTOR)
(616) 241-3396
Entity
Organization
Contact information
Practice address
1028 CASS AVE SE, GRAND RAPIDS, MI 49507-1120
(616) 241-3396
Mailing address
1028 CASS AVE.SE, GRAND RAPIDS, MI 49507
(616) 241-3396
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401011542
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
I HAE ON OTHER IDENTIFERS
—
Enumeration date
06/09/2017
Last updated
07/21/2022
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