Healthcare Provider Details

I. General information

NPI: 1316439516
Provider Name (Legal Business Name): RODNEY EPPERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8544 PONDRIDGE DR
MAINEVILLE OH
45039-8976
US

IV. Provider business mailing address

8544 PONDRIDGE DR
MAINEVILLE OH
45039-8976
US

V. Phone/Fax

Practice location:
  • Phone: 513-673-1053
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2304924
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: