Healthcare Provider Details

I. General information

NPI: 1427753953
Provider Name (Legal Business Name): MACAIAH MARIE RODGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 N WHEELER AVE
SALLISAW OK
74955-2227
US

IV. Provider business mailing address

102 CHITWOOD DR
POTEAU OK
74953-2326
US

V. Phone/Fax

Practice location:
  • Phone: 918-775-5513
  • Fax:
Mailing address:
  • Phone: 785-218-9306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: