Healthcare Provider Details

I. General information

NPI: 1922308592
Provider Name (Legal Business Name): AMY RODGERS LSW, CDMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8747 SQUIRES LN NE
WARREN OH
44484-1649
US

IV. Provider business mailing address

8747 SQUIRES LN NE
WARREN OH
44484-1649
US

V. Phone/Fax

Practice location:
  • Phone: 330-841-3653
  • Fax: 330-841-3541
Mailing address:
  • Phone: 330-841-3653
  • Fax: 330-841-3541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number00112475
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1450364
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: