Healthcare Provider Details

I. General information

NPI: 1316235609
Provider Name (Legal Business Name): PAUL D RHODEA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

962 W US HIGHWAY 30 UNIT 8
SCHERERVILLE IN
46375-1551
US

IV. Provider business mailing address

15127 S 73RD AVE SUITE G
ORLAND PARK IL
60462-4398
US

V. Phone/Fax

Practice location:
  • Phone: 219-864-4363
  • Fax:
Mailing address:
  • Phone: 708-845-5500
  • Fax: 708-845-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33002251A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35000979A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: