Healthcare Provider Details

I. General information

NPI: 1043321466
Provider Name (Legal Business Name): RODNEY JOHN OPSAL A.C.S.W., L.I.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 WAINWRIGHT DR
WALLA WALLA WA
99362-3975
US

IV. Provider business mailing address

77 WAINWRIGHT DR
WALLA WALLA WA
99362-3975
US

V. Phone/Fax

Practice location:
  • Phone: 509-525-5200
  • Fax: 509-527-6113
Mailing address:
  • Phone: 509-525-5200
  • Fax: 509-527-6113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00005190
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: