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General NPI Number Information
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NPI Number | 1144732363
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Entity Type | Individual
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Provider Name | MRS. ANGIE JEAN RODBERG
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Gender | Female
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Dates
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Enumeration Date | 10/27/2017
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Last Update Date | 10/27/2017
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Provider Practice Location Address
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Address Line | 1985 NE 51ST PL
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City | DES MOINES
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State | IA
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Zip | 50313-2517
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Country | US
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Telephone | 515-287-8255
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Fax | 515-209-7081
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Provider Business Mailing Address
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Address Line | 1211 VINE ST
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City | WEST DES MOINES
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State | IA
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Zip | 50265-4472
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Country | US
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Telephone | 515-287-8255
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Fax | 515-209-7081
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 14078
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License Number State | IA
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