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General NPI Number Information
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NPI Number | 1205691425
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Entity Type | Individual
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Provider Name | SHELBY LEEANN RODGERS LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/16/2024
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 11101 N WELLS BYPASS RD
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City | MOUNT VERNON
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State | IL
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Zip | 62864-6588
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Country | US
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Telephone | 618-927-6119
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3988
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City | CARBONDALE
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State | IL
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Zip | 62902-3988
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Country | US
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Telephone | 618-457-5200
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Fax |
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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 | 149026554
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | 149026554
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License Number State | IL
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