MEDICARE: CANDACE JOY RODGERS LCSW

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	104100000X	Social Worker	9923291	CO

General Provider Information

NPI Number	:	1093382830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE JOY RODGERS LCSW

Provider Business Mailing Address
First Line	:	1522 LYLE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-2048
Country	:	US
Telephone Number	:	970-580-4249
Fax Number	:

Provider Business Practice Location Address
First Line	:	1277 KELLY JOHNSON BLVD STE 160
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3992
Country	:	US
Telephone Number	:	719-257-3540
Fax Number	:

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

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	12/11/2024

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