Provider Demographics
NPI:1487616769
Name:RODRIGUEZ, CYNTHIA SCHROEDER (PHD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SCHROEDER
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CASCADE WEST PKWY SE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-591-9000
Mailing Address - Fax:616-591-9060
Practice Address - Street 1:500 CASCADE WEST PKWY SE
Practice Address - Street 2:SUITE 240
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-591-9000
Practice Address - Fax:616-591-9060
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011626103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N20450014Medicare PIN