Healthcare Provider Details

I. General information

NPI: 1992365043
Provider Name (Legal Business Name): MISS RODISHA JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 LOYOLA AVE STE 106
NEW ORLEANS LA
70113-1912
US

IV. Provider business mailing address

909 S BROAD ST
NEW ORLEANS LA
70125-1421
US

V. Phone/Fax

Practice location:
  • Phone: 504-558-9595
  • Fax:
Mailing address:
  • Phone: 504-483-3558
  • Fax: 504-525-4483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15538
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number15538
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: