MEDICARE: JORDAN RODRIGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	P023438	NC

General Provider Information

NPI Number	:	1043162514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN RODRIGUEZ

Provider Business Mailing Address
First Line	:	132 ELIZABETH AVE STE A
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-4992
Country	:	US
Telephone Number	:	704-914-8197
Fax Number	:	980-368-5845

Provider Business Practice Location Address
First Line	:	132 ELIZABETH AVE STE A
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-4992
Country	:	US
Telephone Number	:	704-914-8197
Fax Number	:	980-368-5845

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “ JORDAN RODRIGUEZ ” Practice Location

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