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1053112904 NPI number — IAN MILLER RODEHORST PLPC

NPI Number: 1053112904
Health Care Provider/Practitioner: IAN MILLER RODEHORST PLPC

Information about “1053112904” NPI (IAN MILLER RODEHORST PLPC) exists in 1053112904 in HTML format HTML  |  1053112904 in plain Text format TXT  |  1053112904 in PDF (Portable Document Format) PDF  |  1053112904 in an XML format XML  formats.

NPI Number : 1053112904 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053112904",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RODEHORST",
    "FirstName": "IAN",
    "MiddleName": "MILLER",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PLPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "615 CHEVELLE CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BATON ROUGE",
    "MailingAddressStateName": "LA",
    "MailingAddressPostalCode": "70806-6502",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "225-303-0212",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "615 CHEVELLE CT",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BATON ROUGE",
    "PracticeLocationAddressStateName": "LA",
    "PracticeLocationAddressPostalCode": "70806-6502",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "225-303-0212",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/24/2025",
    "LastUpdateDate": "01/12/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "171M00000X",
          "TaxonomyName": "Case Manager/Care Coordinator",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "PLC10602",
          "LicenseNumberStateCode": "LA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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