1780739177 NPI number — KAREN A. RODRIGUEZ LISW, LMHP, CMSW

Table of content: (NPI 1639321029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780739177 NPI number — KAREN A. RODRIGUEZ LISW, LMHP, CMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
KAREN
Provider Middle Name:
A.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LISW, LMHP, CMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780739177
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 399
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVOCA
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51521-0399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-307-6014
Provider Business Mailing Address Fax Number:
712-307-6015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 N ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVOCA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51521-0399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-307-6014
Provider Business Practice Location Address Fax Number:
712-307-6015
Provider Enumeration Date:
01/24/2007

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: 101YM0800X , with the licence number:  06578 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 816656000 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06578 . This is a "LISW" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1110 . This is a "CMSW" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 2705 . This is a "LMHP" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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