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General NPI Number Information
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NPI Number | 1053660407
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Entity Type | Individual
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Provider Name | JOE A LODGE BSW
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Gender | Male
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Dates
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Enumeration Date | 08/30/2012
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 40 LANDING CIR SUITE 1
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City | CHICO
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State | CA
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Zip | 95973-7901
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Country | US
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Telephone | 530-893-3698
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Fax | 530-893-3748
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Provider Business Mailing Address
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Address Line | 242 N VILLA AVE
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City | WILLOWS
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State | CA
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Zip | 95988-2641
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Country | US
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Telephone | 530-934-6582
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Fax | 530-934-6592
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW124911
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License Number State | CA
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