Healthcare Provider Details

I. General information

NPI: 1205376803
Provider Name (Legal Business Name): JARED LADANE RODGERS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 03/15/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 OAK HILL DR
WHITE HALL AR
71602-8607
US

IV. Provider business mailing address

PO BOX 20083
WHITE HALL AR
71612-0083
US

V. Phone/Fax

Practice location:
  • Phone: 501-513-7103
  • Fax:
Mailing address:
  • Phone: 501-513-7103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10212-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: