Healthcare Provider Details

I. General information

NPI: 1033420831
Provider Name (Legal Business Name): LORI R. RODRIQUEZ-FLETCHER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E 3RD ST
ALLIANCE NE
69301-3825
US

IV. Provider business mailing address

PO BOX 651
ALLIANCE NE
69301-0651
US

V. Phone/Fax

Practice location:
  • Phone: 308-763-9261
  • Fax: 308-761-3990
Mailing address:
  • Phone: 308-763-9261
  • Fax: 308-761-3990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4093
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1457
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: