Healthcare Provider Details

I. General information

NPI: 1689786188
Provider Name (Legal Business Name): CAROLE JEAN RODON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501B W ASH ST
COLUMBIA MO
65203-4609
US

IV. Provider business mailing address

2501B W ASH ST
COLUMBIA MO
65203-4609
US

V. Phone/Fax

Practice location:
  • Phone: 573-442-4161
  • Fax: 573-442-4162
Mailing address:
  • Phone: 573-442-4161
  • Fax: 573-442-4162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY01536
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: