Basic Information
Provider Information
NPI: 1003153594
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROTHNEY
FirstName: VERONICA
MiddleName: LYNN
NamePrefix:  
NameSuffix:  
Credential: LMSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: YOUNG
OtherFirstName: VERONICA
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: LMSW
OtherLastNameType: 1
Mailing Information
Address1: 610 S BURDICK ST
Address2:  
City: KALAMAZOO
State: MI
PostalCode: 490075221
CountryCode: US
TelephoneNumber: (269) 381-3700
FaxNumber: 2693813810
Practice Location
Address1: 601 JOHN ST STE M-170
Address2:  
City: KALAMAZOO
State: MI
PostalCode: 490075366
CountryCode: US
TelephoneNumber: 2693815060
FaxNumber: 2693811655
Other Information
ProviderEnumerationDate: 01/03/2013
LastUpdateDate: 03/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X6801094550MIY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


Home