1376741496 NPI number — MS. MICHELE A. RODGAARD-MCGINLEY LCSW

Table of content: MS. MICHELE A. RODGAARD-MCGINLEY LCSW (NPI 1376741496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376741496 NPI number — MS. MICHELE A. RODGAARD-MCGINLEY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODGAARD-MCGINLEY
Provider First Name:
MICHELE
Provider Middle Name:
A.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RODGAARD
Provider Other First Name:
MICHELE
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376741496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 889
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAHEO
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-332-5015
Provider Business Mailing Address Fax Number:
808-332-5015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2-2514 KAUMUALII HWY.
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
KALAHEO
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-332-5015
Provider Business Practice Location Address Fax Number:
808-332-5015
Provider Enumeration Date:
07/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS 16185 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: LCSW 3457 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LCSW3457 . This is a "SOCIAL WORKER LICENSE NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: GR0051600 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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