Healthcare Provider Details

I. General information

NPI: 1801029087
Provider Name (Legal Business Name): JENNIFER A. RHODES MSW,LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 PEACH ORCHARD ROAD
MC CONNELLSBURG PA
17233
US

IV. Provider business mailing address

214 PEACH ORCHARD ROAD
MC CONNELLSBURG PA
17233
US

V. Phone/Fax

Practice location:
  • Phone: 717-485-6120
  • Fax: 717-485-6106
Mailing address:
  • Phone: 717-485-6120
  • Fax: 717-485-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberSW127519
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1023718600002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: